DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20170450

Major infections in children with nephrotic syndrome

Krishnan C., Rajesh T. V., Shashidhara H. J., Jayakrishnan M. P., Geeta M. G.

Abstract


Background: Infections remain an important cause of mortality and morbidity in children with nephrotic syndrome. It triggers the onset of disease or relapses and may also be responsible for a poor response to steroid therapy. Understanding the type and severity of infections is important in the appropriate management of these children. This study was conducted to determine the frequency and type of major infections in children with nephrotic syndrome.

Methods: A longitudinal descriptive study was conducted in a tertiary center, in children between 1 and 12 years with nephrotic syndrome satisfying the International Study of kidney disease in children (ISKDC) criteria, from March 2013 to September 2014. Major infections were defined as infections affecting deep organs and tissues which warrant hospitalization.

Results: A total of 246 children with nephrotic syndrome were enrolled, of whom 46 children developed 48(19.6%) episodes of major infections. Thirteen (27%) major infections occurred in the initial episode and 35(73%) in relapse cases. Pneumonia (41.7%) was the commonest infection, followed by urinary tract infection (25%), septicemia (16.7%), spontaneous bacterial peritonitis (8.3%), cellulitis (4.2%), perinephric abscess (2.1%) and pulmonary tuberculosis (2.1%). Two children had multiple infections. Methicillin resistant staphylococcus aureus was the causative organism in 5 children with septicemia. A 24% of bacterial isolates were multidrug resistant.

Conclusions: Major infections remain an important complication of nephrotic syndrome in children, especially during relapses. Drug resistant organisms should be considered while treating major infections in these children.


Keywords


Children, Major infections, Nephrotic syndrome, Peritonitis, Septicemia

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References


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.

Gulati S, Kher V, Gupta A, Arora P, Rai PK, Sharma RK. Spectrum of infections in Indian children with nephrotic syndrome. Pediatr Nephrol. 1995;9:431-4.

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

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

Sinha A, Hari P, Sharma PK, Gulati A, Kalaivani M, Mantan M, et al. Disease course in steroid sensitive nephrotic syndrome. Indian Pediatr. 2012;49:881-7.

Chopra D, Kini P, Bhaskaranand N, Aroor S. Spectrum of infections in children with nephrotic syndrome. Int J Infectious Diseases. 2010:80;14.

Ajayan P, Krishnamurthy S, Biswal N, Mandal J. Clinical spectrum and predictive risk factors of major infections in hospitalized children with nephrotic syndrome. Indian Pediatr. 2013;50:779-81.

Bagga A, Ali U, Banerjee S, Kanitkar M, Phadke KD, et al. Management of steroid sensitive nephrotic syndrome: revised guidelines. Indian Pediatr. 2008;45:203-14.

Bagga A, Srivastava RN. Nephrotic syndrome. In: Srivastava RN, Bagga A. Pediatric Nephrology. 5th edition. New Delhi: Jaypee Publishers. 2005:195-234.

Wei CC, Yu IW, Lin HW, Tsai AC. Occurrence of infection among children with nephrotic syndrome during hospitalizations. Nephrology. 2012;17:681-8.

Moorani KN. Infections are common cause of relapse in children with nephrotic syndrome. Pak Paed J. 2011;35(4):213-9.

Moorani KN, Mukesh Raj. Spectrum of infections in children with newly diagnosed primary nephrotic syndrome. Pak J Med Res. 2012;51:1:10-4.

Dinjamro B, Shankarlal, Shaikh A, Jamro S. Types of infection in primary nephrotic syndrome. Pak Paed J. 2012;36(2):87-91.

Rizzo MC. The impact of the environment in the respiratory tract. J Pediatr. 1998;74(1):13-20.

Niaudet P, Boyer O. Idiopathic nephrotic syndrome in children: clinical aspects. In: Avner ED, Harmon WE, Niaudet P, Yoshikawa N, editors. Pediatric Nephrology 6th edition. United Kingdom: Springer; 2009:667-702.

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

Srivastava RN. 50 Years of nephrotic syndrome in children, and hereafter. Indian Pediatr. 2013;50:107-10.

Tain YL, Lin G, Cher TW. Microbiological spectrum of septicemia and peritonitis in nephrotic children. Pediatr Nephrol. 1999;13(9):835-7.

Menif K, Bouziri A, Khaldi A, Hamdi A, Belhadj S, Borgi A, et al. Community-associated methicillin-resistant Staphylococcus aureus infections in a pediatric intensive care unit. J Infect Dev Ctries. 2011;5(8):587-91.

Naidoo1 R, Nuttall J, Whitelaw A, Eley B. Epidemiology of staphylococcus aureus Bacteraemia at a Tertiary Children’s Hospital in Cape Town, South Africa. PLOS ONE. 2013;8:78396.

Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet. 2003;362:629-39.

Hingorani SR, Weiss NS, Watkins SL. Predictors of peritonitis in children with nephrotic syndrome. Pediatr Nephrol. 2002;17:678-82.

Gipson DS, Massengill SF, Yao L, Nagraj S, Smoyer WE, Mahan JD, et al. Management of childhood onset nephrotic syndrome. Pediatrics. 2009;124:747-57.

Uncu N, Bulbul M, Yildiz N. Primary peritonitis in children with nephrotic syndrome: results of a 5 year multicenter study. Eur J Pediatr. 2010;169:73-6.

Wilkes JC, Nelson JD, Worthen HG, Morris M, Hogg RJ. Response to pneumococcal vaccination in children with nephrotic syndrome. Am J Kidney Dis. 1982;2(1):43-6.

Adhikari M, Coovadia HM. Abdominal complications in black and Indian children with nephrotic syndrome. S Afr Med J. 1993;83:253-6.

Ilyas M, Roy S, III, Abbasi S, Leggiadro RJ, English BK, Wyatt RJ. Serious infections due to penicillin-resistant Streptococcus peneumoniae in two children with nephrotic syndrome. Pediatr Nephrol. 1996;10:639-41.

Kidney disease: improving global outcomes (KDIGO) Glomerulonephritis work group. KDIGO clinical practice guideline for glomerulonephritis. Kidney Inter Suppl. 2012;2:139-274.

Neelam T, Shiv SC, Pediatric urinary tract infections in a tertiary care center from north India. Indian J Med Res. 2010;131:101-5.

Mohammed A, Mohammed S, Asad UK. Etiology and antibiotic resistance patterns of community-acquired urinary tract infections in JNMC Hospital Aligarh, India. Ann Clin Microbial Antimicrob. 2007;6:4-11.