Clinical profile of children with nephrotic syndrome not on glucorticoid therapy, but presenting with infection

Alwadhi, RK; Jl, Misset; Rath, Bimbadhar

doi:10.1111/j.1440-1754.2004.00285.x

Cited by 82 publications

(83 citation statements)

References 8 publications

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“…[47,48]. In developing countries gram negative organism such as Escherichia coli and Klebsiella pneumonia are also common [44].…”

Section: (I) Infectionmentioning

confidence: 99%

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Steroid Sensitive Nephrotic Syndrome in Children

Bhimma¹

2014

J Nephrol Ther

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Nephrotic Syndrome (NS) is one of the most frequent glomerular diseases seen in children. Children who go into complete remissin following treatment with corticosteroids are classified as having "steroid sensitive" NS. In developed countries over 80% of children with idiopathic NS have steroid sensitive disease although response to steroids is somewhat tempered in developing countries, especially in black children, the majority of whom have steroid resistant disease.The exact pathogenesis of this condition remains elusive. Podocyte injury and proteinuria are the two main issues in the pathogenesis. Recent studies suggest alterations in both innate and adaptive immune responses. There is release of cytokines by T-cells as well as a strong contribution of B-cell immunity. Genetic studies have reported human leucocyte antigen (HLA) class II antigens DR and DQ associations linked to steroid sensitive NS and in small case studies, single gene mutations e.g. PLCE1 although to date no homozygous mutations in NPHS1 or NPHS2 and WT-1 genes have been reported.Most children with steroid sensitive NS have multiple relapses and a significant percentage also develop steroid dependent NS. These children receive multiples courses of steroids and are at high risk of developing steroid toxicity. Patient with frequent relapses who develop steroid dependency thus require alternative treatment. Steroids sparing agents used include levamisole, cyclophosphamide, mycophenolate mofetil (MMF), calcineurin inhibitors (cyclosporine and tacrolimus), rituximab and vincristine. The steroid-sparing effects of these agents have greatly reduced the adverse effects seen with long-term use of steroids.Despite the wide arsenal of agents available, therapy needs to be individualised to achieve optimal care of each child. More randomised controlled trials are required to evaluate the therapeutic and economic efficacy of this agent, define criteria for selection of patients for use of particular agents and to determine the safety profile of these drugs in children.This article reviews the epidemiology, pathogenesis, clinical presentation, diagnosis, complications, management and long term outcome of children with steroid sensitive NS.

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“…[47,48]. In developing countries gram negative organism such as Escherichia coli and Klebsiella pneumonia are also common [44].…”

Section: (I) Infectionmentioning

confidence: 99%

“…Ascites and pleural effusions provide a natural culture medium for bacterial growth thus predisposing to pneumonia, empyema, and peritonitis [44]. Other serious infections include septicaemia, meningitis and cellulitis [45,46].…”

Section: (I) Infectionmentioning

confidence: 99%

Steroid Sensitive Nephrotic Syndrome in Children

Bhimma¹

2014

J Nephrol Ther

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“…Infection in nephrotic syndrome may be vague or non-specific which may delay early diagnosis having various effect on patient with nephrotic syndrome 5 . Of all infections, urinary tract infection are of special interest because most of the urinary tract infection in nephrotic syndrome are asymptomatic 6 . Besides, in general, younger the child, the sign symptoms of urinary tract infection are less localizing 7 .…”

Section: Introductionmentioning

confidence: 99%

Urinary Tract Infection in Nephrotic Syndrome: A Hospital Based Cross-Sectional Study

Barua

Sultana

Babul

et al. 2017

Chatt Maa Shi Hosp Med Coll J

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Background: Urinary Tract Infection (UTI) is a common infection in nephrotic syndrome and have a propensity for long term renal damage. It may be an important cause of poor steroid response. The objective is to study the frequency and etiological organisms of urinary tract infection in idiopathic nephrotic syndrome children. Methods: This Comparative cross-sectional study was conducted in the Pediatric ward of Chittagong Medical College Hospital, Chittagong from 01.01.2009 to 31.12.2009. 52 nephrotic syndrome children diagnosed by serum albumin, serum cholesterol and 24 hours total urinary protein or protein creatinin index were included. After elaborate clinical evaluation, urine for R/M/E and C/S was done in all patients. Data regarding pyuria, hematuria, etiological organisms were analyzed by statistical method. Results: UTI was found in 30.8% nephrotic children and in majority cases (68.8%) they were asymptomatic. Male female ratio among UTI patients was 1:1. Mean serum cholesterol in nephrotic syndrome with UTI was higher than that of children without UTI (418.94 mg/dl vs 352.03 mg/dl, p value < 0.05).Pyuria had poor association with definite UTI (p value > 0.05). E-coli was the commonest organism isolated in urine culture followed by klebsiella. Conclusion: UTI is one of the most common infections in nephrotic syndrome and may be asymptomatic. It should be screened in every nephrotic child routinely.

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“…Of all infections, urinary tract infections are of special interest because most of the urinary tract infections in nephrotic syndrome are asymptomatic [5] . In general, younger the child, the sign symptoms of urinary tract infection is less localizing [6] .…”

Section: Introductionmentioning

confidence: 99%