Immunosuppression increases the risk of infection leading to emergency department visits or hospitalization in patients with glomerular disease, a new study confirms.

Among 2388 adults and children (36% aged less than 18 years) with glomerular disorders from North America and Europe in the CureGN study, 15% experienced at least 1 infection-related emergency department visit or hospitalization over a median 3.2 years. Compared with no immunosuppression, exposure to steroids or a steroid plus another immunosuppressant were both significantly associated with a 2.7-fold increased risk of a first infection requiring acute care, Dorey A. Glenn, MD, MPH, of the University of North Carolina, Chapel Hill, and colleagues reported in Kidney Medicine. Exposure to nonsteroid immunosuppressants alone was significantly associated with a 1.7-fold increased risk of infection requiring an emergency department visit or hospitalization..

The most common infections included pulmonary/lower respiratory (30%), multisystem (23%), upper respiratory tract/throat (19%), genitourinary (11%), and gastrointestinal infection (11%).

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Patients had biopsy-proven minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), or immunoglobulin A nephropathy (IgAN)/vasculitis. They received adrenocorticotropic hormone, azathioprine, calcineurin inhibitor, cyclophosphamide, mycophenolic acid, and/or rituximab.

Information on immunosuppressant doses was lacking. The study also lacked a control group without glomerular disease. The investigators used time-varying marginal structural models to reduce the influence of disease activity on results.

“Across multiple drug classes, immunosuppression exposure that included corticosteroids was associated with higher risk of first infection,” Dr Glenn’s team wrote. “These findings strongly support efforts to develop novel, and refine existing, treatment strategies that minimize or altogether forgo use of corticosteroids for patients with MCD, FSGS, MN, and IgAN.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Glenn DA, Zee J, Mansfield S, et al. Immunosuppression exposure and risk of infection-related acute care events in patients with glomerular disease: an observational cohort study. Kidney Med. 2022 Oct 1;4(11):100553. doi:10.1016/j.xkme.2022.100553