The risk factors for children with primary nephrotic syndrome: a systematic review and meta-analysis

BACKGROUND: To evaluate the risk factors of primary nephrotic syndrome (PNS) with urinary tract infection (UTI) in children. METHODS: Multiple databases including PubMed, Excerpta Medica Database (EMBASE), Web of Science (WOS), the Cochrane Library, and China National Knowledge Infrastructure (CNKI) were used to search for relevant studies, which were full-text articles involved in the evaluation of differences between PNS with UTI and without UTI. All included articles were assessed for quality and the data analyses were conducted with Review Manager (5.4). Forest plots, sensitivity analysis, and bias analysis were also performed on the included articles. RESULTS: Eight studies were included in this meta-analysis, with a total of 3,274 patients. Meta-analysis showed that a low level of serum albumin [mean difference (MD): −0.32 g/dL; 95% confidence interval (CI): (−0.55, −0.08); P=0.008], a low level of serum total protein [MD: −0.16 g/dL; 95% CI: (−0.20, −0.12); P<0.00001], a high level of urinary protein [MD: 5.09 mg/d; 95% CI: (3.13, 7.05); P<0.00001], a lower level of serum urea nitrogen [MD: −0.10 mg/dL; 95% CI: (−0.18, −0.02); P=0.01], and a higher level of serum cholesterol [MD: 2.26 mg/dL; 95% CI: (0.74, 3.78)] had a higher risk of PNS with UTI. There was no obvious publication bias among included studies. DISCUSSION: Our research demonstrated that a low level of serum albumin, a low level of serum total protein, a high level of urinary protein, a low level of serum urea nitrogen, and a high level of serum cholesterol were the risk factors of PNS with UTI in children.