PPD before Steroid treatment therapy in nephritic syndrome

In some reported more than one-third of people in the word are infected and have Latent tuberculosis infection (LTBI) and about 5-10% of them may progress to active tuberculosis (TB) within their lifetime.LTBI is an important diseases and treatment of LTBI in all patients and especially children is very critical. So, screening of all patients that who had the high risk of LTBI such as HIV or in immunodeficent patients are recommended. Primary nephrotic syndrome (NS) is the most common glomerular disease in children. NS was defined to heavy proteinuria, generalized edema, hyperlipidemia and hypoproteinemia.All children that have primary NS were treated empirically with high doses of corticosteroids (CS) at presentation and relapses.Children with NS are immunocompromised patients before starting of CS and be more immune-deficient as a consequence of immunosuppressive therapy because systemic corticosteroid use could decrease systemic immunity. According to impaired defense mechanism of children with NS, the risk of reactivation of LTBI is higher than others and may leading to the occurrence of tuberculosis.Therefore, it was recommended to done TB screening test in children with NS before starting of CS. There is disagreement about universal or selected cases screening and the method of screening by the tuberculin skin test (TST) or gamma interferon (ϒ-interferon) for detection of LTBI.The first method is cheap, easy to perform and was done by every laboratory, but the second method was more expensive and need high technology equipment. Of course, the tuberculin skin test (TST) may have a lower diagnostic value, probably due to this patients are immunocompromised