Influence of nephrotic state on the infectious profile in childhood idiopathic nephrotic syndrome

Abstract

Patients with idiopathic nephrotic syndrome present alterations in their cellular and humoral immune reactions that predispose them to the development of infectious processes.PURPOSE: To characterize the infectious processes in patients with idiopathic nephrotic syndrome. PATIENTS AND METHODS: Ninety-two children and adolescents with idiopathic nephrotic syndrome were assessed retrospectively. The types of infection were grouped as follows: upper respiratory tract infections; pneumonia; skin infections; peritonitis; diarrhea; urinary tract infection ; herpes virus; and others. The patients were divided into 2 groups: Group I (steroid-responsive) n = 75, with 4 subgroups-IA (single episode) n = 10, IB (infrequent relapsers) n = 5, IC (frequent relapsers) n = 14, and ID (steroid-dependent) n = 46; and Group II (steroid-resistant) n = 17. The incidence-density of infection among the patients was assessed throughout the follow-up period. Comparisons for each group and subgroup were done during the periods of negative and nephrotic proteinuria.RESULTS: The analysis revealed a greater incidence-density of infections during the period of nephrotic proteinuria in all the groups and subgroups, with the exception of subgroup IA. During the period of nephrotic proteinuria, subgroups IC, ID, and Group II presented a greater incidence-density of infections as compared to subgroup IA. For the period of negative proteinuria, there was no difference in the incidence-density of infections between the groups and subgroups. Upper respiratory tract infections were the most frequent infectious processes.CONCLUSION: The nephrotic condition, whether as part of a course of frequent relapses, steroid dependence, or steroid resistance, conferred greater susceptibility to infection among the patients with idiopathic nephrotic syndrome. The results of this study suggest that the best preventive action against infection in this disease is to control the nephrotic state.

Infections in Children with Newly Diagnosed Idiopathic Nephrotic Syndrome

“…Two studies from India & Nigeria found it as the most common infection and two studies from Pakistan & Taiwan found it as the 2 nd most common infection 1,8,[10][11] . Organisms causing UTI were almost similar to other studies though one study found staphylococcus aureus as the commonest organism 1,[9][10][11] . We found only one case of Tuberculosis.…”

“…A recent study in Pakistan showed that ARI was the commonest infection in children with newly diagnosed primary nephrotic syndrome. 1 Three studies from Iran, Taiwan & Brazil also found similar result [7][8][9] . One study from India found it as the 3 rd most common infection 10 .…”

“…Similar result was observed in a study from Brazil. 9 Study from Pakistan showed 11.6% cases of diarrhea associated with NS 1 .…”

“…Peritonitis was found in different studies abroad 1,[6][7][8][9][10][12][13] . Peritonitis is common in relapse cases, but we had studied only the 1 st attack of NS.…”

To study the frequency, etiology and predisposing factors of urinary tract infection in children with nephrotic syndrome in Eastern Odisha Region: a hospital based study

“…ascites as a potential culture medium and defective cell mediated immunitiy is responsible for increased incidence of infections in nephrotic syndrome. 7,8 Younger age, severe clinical types of nephrotic syndrome with severe ascites, use of cytotoxic drugs compared to prednisolone therapy alone and the presence of nephrotic range proteinuria itself have been identified as risk factors for the infections, whereas serum cholesterol more than 400 mg/dl and hypoalbuminemia less than 1.5 gm/dl is specifically identified for spontaneous bacterial peritonitis. 4,6,7,9,10 In children with nephrotic syndrome organism frequently encountered in infection are pneumococci, haemophilus influenze, beta haemolytic streptococci and gram negative bacteria.…”