Urinary tract infection in nephrotic syndrome in pediatric age group: a hospital based cross-sectional study

Authors

  • Subinay Mandal Department of Pediatric Medicine, BSMCH, Bankura, West Bengal, India
  • Subhendu Samanta Department of Pediatric Medicine, BSMCH, Bankura, West Bengal, India
  • Sabyasachi Bakshi Department of General Surgery, BSMCH, Bankura, West Bengal, India
  • Devidutta Dash Department of Pediatric Medicine, BSMCH, Bankura, West Bengal, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20203177

Keywords:

Hematuria, Nephrotic syndrome, Pyuria, Urinary tract infection

Abstract

Background: Nephrotic syndrome, characterized by the presence of heavy proteinuria, hypoalbuminemia, edema and hyperlipidemia, is a common renal disorder in pediatric population. Aim of this study were to find out the prevalence of Urinary Tract Infection (UTI) in nephrotic syndrome, bacterial etiologies and antibiotic sensitivity pattern.

Methods: After matching the criteria, 82 cases, were taken for this prospective, single center, observational study. The diagnosis was confirmed by bacterial culture. This is an institution based cross-sectional descriptive observational study. All newly diagnosed and relapse cases of nephrotic syndrome based on inclusion exclusion criteria was included in this study. Respondent was either of the parents or caregiver of the study subjects. Analysis of all data was done by appropriate statistical software (SPSS-23).

Results: Among 82 participants evaluated with nephrotic syndrome 29.3% participants had UTI, majority 66.7% were asymptomatic and 33.3% were symptomatic. Significant microscopic hematuria were found in 20.7% study subjects and significant pyuria were found in 58.54% study subjects. Majority of UTI caused by E.coli 33.3% followed by Klebsiella 25%, Proteus 16.7%, Staphylococcus aureus 12.5%, Citrobacter, Acinetobacter and mixed growth were found in 4.2% each. Mean serum cholesterol of group with UTI was 422.13±34.65 and group without UTI was 307.43±26.13. The variation amongst the two groups were found to be significant (p=0.0001).

Conclusions: The children with nephrotic syndrome are frequently predisposed to UTI and in most cases it is asymptomatic, often undiagnosed. Higher serum cholesterol level may predispose the nephrotic child for UTI.

References

Bagga A. Management of steroid sensitive nephritic syndrome: Revised guidelines. Indian Pediatr. 2008;45:203-14.

Koskimies O, Vilska J, Rapola J, Hallman N. Long-term outcome of primary nephrotic syndrome. Arch Dis Child. 1982;57:544-8.

Arneil GC. The nephrotic syndrome. Pediatr Clin North Am. 1971;18:547-59.

Feehally J, Kendell NP, Swift PGF, Walls J. High incidence of minimal change nephrotic syndrome in Asians. Arch Dis Child. 1985;60:1018-20.

Sharples PM, Poulton J, white RHR. Steroid responsive nephrotic syndrome is more common in Asian. Arch Dis Child 1985;60:1014-7.

McIntosh N, Helms P, Smyth R. Forfar and Arneil’s Test Book of Paediatrics. 6th edn. Edinburgh: Churchil Linvingstone; 2003:633-636.

Neuhaus TJ, Fay J, Dillon MJ. Alternative treatment to corticosteroids in steroid sensitive idiopathic nephrotic syndrome. Arch Dis Child. 1994;71:522-6.

Nash MA, Edelmann CM, Bernstuin J, Barnet HL. Pediatric kidney disease. 2nd Ed. Boston/Taronata/London: Little, Brown and Company; 1978:1247-1280.

Eduardo HG. Effect of lipoid nephrosis cytokine on glomerular sulfated compounds and albuminuria. Pediatr Nephrol. 1995;9:587-93.

Soeiro EMS, Koch VH, Fujimura MD, Okay Y. Influence of nephrotic state on the infectious profile in childhood idiopathic nephrotic syndrome. Rev. Hosp Clin Fac Med. 2004;59(5):273-8.

Gulati S, kher V, Arora A, Gupta S, Kale S. Urinary tract infection in nephrotic syndrome. Pediatr Infect Dis J. 1996;15:237-40.

MacDonald NE, Wolfish N, McLaine P, Phipps P, Rossier E. Role of respiratory viruses in exacerbations of primary nephrotic syndrome. J Pediatr. 1986 Mar 1;108(3):378-82.

Alwadhi RK, Mathew JL, Rath B. Clinical profile of children with nephrotic syndrome not on glucocorticoid therapy but presenting with infection. J Paediatr Child Health. 2004;40:28-32.

George H, McCracken JR. Diagnosis and management of acute urinary tract infection in infants and children. The Pediatr Infect Dis J. 1987;6:107-12.

Gulati S, Gupta A, Kher V, Sharma RK. Steroid response pattern in Indian children with nephrotic syndrome. Acta Paediatr. 1995;83:530-3.

Uwaezuoke SN. Steroid sensitive nephrotic syndrome in children: triggers of relapse and evolving hypotheses on pathogenesis. Italian J Pediar. 2015;41(19):2-6.

Gulati S, Arora P, Sharma RK, Kher V, Gupta A, Rai PK. Spectrum of Infections in Indian Children with Nephrotic Syndrome. Pediatr Nephrol. 1995;9:431-4.

Barua T, Sultana R, Babul FK, Iqbal S, Sharma JD, Dutta PK. Urinary tract infection in nephrotic syndrome: a hospital based cross-sectional study. Chattagram Maa-O-Shishu Hospital Med Coll J. 2016;15(2):41-4.

Kundu LC, Saha AK, Hassan MK, Kundu A. Urinary Tract Infection in Nephrotic Syndrome-A study of 62 cases at Faridpur Medical College Hospital. Faridpur Med Coll J. 2018 Aug 24;13(1):35-9.

Senguttuvan P, Ravanan K, Prabhu N, Tamilarasi V. Infections encountered in childhood nephrotics in a pediatric renal unit. Indian J Nephrol. 2004 Oct;14:85-8.

Kumar RR, Ahmer R. Hidden Urinary Tract Infection in Children with Nephroti Syndrome. JMSCR. 2017;5(5):2472-5.

Basu B, Baur D, Datta S, Bose M, Saha A. Bacteriological profile and sensitivity to antibiotics of common isolates responsible for urinary tract infection in nephrotic children. Int J Nephrol Kidney Fail. 2015;1:1-3.

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Published

2020-07-22

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Original Research Articles