Anti-HBs Titer in Children With Nephrotic Syndrome Admitted to a Tertiary Care Hospital

Nephrotic syndrome (NS) is the most common pediatric renal disease. Immune dysregulation, prolonged immunosuppressive treatment, and recurrent prolonged proteinuria in NS cause alterations in serum immunoglobulins, especially hypogammaglobulinemia. Thus, anti-HBs titer may be reduced in NS patients. We assessed anti-HBs titer among hepatitis B-vaccinated children with NS.

This case-control study was conducted at the Department of Paediatrics of the Institute of Child & Mother Health, Dhaka, from July 2020 to June 2021. Sixty-one children with primary and recurrent NS previously vaccinated according to the expanded programme on immunization program were evaluated for anti-HBs titer and compared with 61 age- and sex-matched healthy children.

Protective anti-HBs titer was found in 29(47.5%) and 40(65.6%) cases in the case and control groups, respectively. The mean anti-HBs titer was 37.2±35.5 IU/L in the case group and 55.7±28.3 IU/L in the control group, which showed a significant difference between the groups. The mean anti-HBs titer was 52.9±35.5 IU/L in the first attack, 33.9±36.8 IU/L in the infrequent relapse nephrotic syndrome (IFRNS), and 22.2±27.41 IU/L in the frequent relapse nephrotic syndrome (FRNS), respectively. The difference was also significant statistically. The mean anti-HBs titer was lower in the FRNS and IFRNS and significant in the FRNS compared to the first attack. The mean anti-HBs titer was significantly (P<0.05) lower in the IFRNS and FRNS compared to the controls.

Anti-HBs titer was found significantly lower than the protective level in the first attack and relapse cases of NS.