Spectrum of infections in Indian children with nephrotic syndrome

Abstract

We conducted a retrospective analysis of infections in 154 children (114 boys, 40 girls) with nephrotic syndrome who satisfied the International Study of Kidney Disease in Children criteria. Their mean age at onset of symptoms was 6.2 years (range 6 months to 16 years) and the mean duration of follow-up was 32 months (range 6-55 months). One or more infectious complications were observed in 59 of the 154 children (38%), with urinary tract infection being the commonest (13.7%), followed by pulmonary tuberculosis (10.4%), peritonitis (9.1%), skin infections (5.2%), upper respiratory infections (5.2%), lower respiratory tract infections (3.9%) and pyomeningitis (0.6%). There were 3 deaths, the mortality in 2 patients being attributable to infections. There was no significant difference between children who developed infection and those who didn't in terms of age of onset, sex, duration of disease, serum creatinine, blood urea nitrogen and 24-h proteinuria. However, the children who developed infectious complications had significantly higher serum cholesterol levels (P < 0.01) and lower serum albumin levels (P < 0.02). The frequency of infections was higher in children who were frequent relapsers, steroid dependent and subsequent non-responders (28/60) compared with infrequent relapsers and initial non-responders (29/94).

Infections in Children with Newly Diagnosed Idiopathic Nephrotic Syndrome

“…In two studies abroad, it was 0.64% & 0.6% 1,6 . This might be due to small sample size in our study.…”

“…We found only one case of Tuberculosis. But two Indian studies found it as 2 nd & 4 th most common infection (10.4% & 5% respectively) 6,10 . This difference might be due to the fact that all cases were not screened for tuberculosis and high success rate of immunization in Bangladesh might influence the result.…”

“…ARI was the commonest infection in this study. Gulati et al found urinary tract infection as the commonest one 6 . A recent study in Pakistan showed that ARI was the commonest infection in children with newly diagnosed primary nephrotic syndrome.…”

“…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.…”

“…Infectious episodes in nephrotic patients are responsible for high morbidity and can also cause an inadequate response to corticosteroid therapy and recurrences among patients in remission 5 . Determining the type of infection is important, not only from the therapeutic point of view, but also to establish preventive measures 6 . The objective of the study was to determine the types of infection associated with idiopathic nephrotic syndrome (INS) and to alert the physicians about this so that they can take preventive and therapeutic measures more promptly.…”