Study Of Prevalence of Toxoplasmosis in Some Renal Diseases in Children: Is There an Association?

Background: Toxoplasmosis, a widespread protozoal disease caused by the obligatory intracellular Toxoplasma gondii (TG). Chronic kidney disease (CKD) is a disease characterized by progressive damage and loss in kidney functions. End stage renal disease (ESRD) is known as CKD with GFR less than 15ml/min. Nephrotic syndrome (NS) is defined as heavy proteinuria that ultimately ends in hypoalbuminemia, hyperlipidemia and generalized edema. Patients with CKD and ESRD are immune compromised so more liable to increased incidence of infections, especially opportunistic infections. Nephrotic syndrome ,90% of cases, is of unknown etiology but some papers suggest toxoplasmosis as a cause. Aim: To evaluate prevalence of toxoplasmosis in CKD patients, hemodialysis patients and nephrotic cases and possible association between nephrotic syndrome and toxoplasmosis. Methods: This case-control study included 200 children, 50 of them were CKD patients, 50 were end-stage renal disease (ESRD) on regular hemodialysis, 50 were nephrotic cases newly diagnosed and 50 were control children age and sex matched. Laboratory investigations included CBC, urine analysis, Serum creatinine and estimated GFR, serum albumin and protein/creatinine ratio in patients with nephrotic syndrome, Toxoplasmosis immunoglobulins IgM, IgG. Results: Insignificant difference was recorded between CKD, haemodialysis, nephrotic and control groups concerning toxoplasmosis IgM. In contrast, there was a significant difference between studied groups regarding toxoplasma IgG where prevalence of toxoplasmosis IgG in dialysis group is more. No significant correlation between positive Toxoplasma cases and clinical picture. No significant correlation between positive Toxoplasma cases and staging among CKD. No positive toxoplasma cases either IgG or IgM in nephrotic cases. No significant association between positive Toxoplasma cases and (access and duration of dialysis) among dialysis group. Conclusion: Children with different renal diseases appeared to have different risks for Toxoplasma seropositivity compared to healthy subjects, suggesting their higher risk for toxoplasmosis in dialysis patients. Keyword: Chronic Kidney Disease, Haemodialysis, Nephrotic Syndrome, Toxoplasma Gondii