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
Keywords:Childhood, Nephrotic Syndrome, Prevalence, UTI
Background: The increased prevalence of infection in nephrotic syndrome is due to immunoglobulin loss, defective T cell function, and presence of ascites, relative malnutrition, and immunosuppressive therapy and associated with other factors. The objective of this study was to study the incidence, aetiology and the antibiotic sensitivity pattern of urinary tract infections (UTI) in children at presentation of nephrotic syndrome (NS).
Methods: A retrospective hospital-based study carried out in IMS and SUM Hospital, Bhubaneswar, India. Seventy six children aged between two to twelve years with a diagnosis of NS at the time of were studied from April 2014 to March 2016.
Results: The mean age of males was 5.9±0.5years and females are 6.2±0.8years. Pyuria was noted in 44 (57.89%) of the patients. Boys were more commonly affected with urinary tract infection than girls with a ratio of 1.9:1. UTI is the most common encountered infection and was predominantly caused by E. Coli in 18 (39%), Klebsiella species 7 (15.21%) and culture negative in 8 (17.28%) cases. There was high in vitro resistance of these organisms to cefixime and ampicillin but sensitive to cefotaxime, amikacin, ceftriazone , piperacillin- tazobactum and vancomycin.
Conclusions: It is recommended that UTI should be sought for in patients with nephrotic syndrome and treatment should be prompt and appropriate taking into account of etiology and predisposing factors. UTI is one of the most common infections accompanying NS due to many factors. A high index of suspicion and early institution of appropriate antibiotics will help in reducing morbidity and mortality.
International study of kidney disease in Children. Minimal change nephrotic syndrome in children, deaths occurringduring the first five to fifteen years. Pediatrics. 1984;173:497-501.
Gorensek MJ, Lebel MH, Nelson JD. Peritonitis in children with nephrotic syndrome. Pediatrics. 1988;81:849-56.
Wifert CM, Katz SL. Etiology of bacterial sepsis in nephrotic syndrome children. Pediatrics. 1968;42:840-3.
Park SJ, Shin J. Complications of nephrotic syndrome. Korean J Pediatr. 2011;54(8):322-8.
Ajayan P , Krishnamurthy S, Biswal N, Mandel J. clinical spectrum and predictive risk factors of major infections in hospitalized children with nephrotic syndrome. Indian Pediatr. 2013;50(8):779-81.
Wei CC, Yu IW, Lin HW, Tsai AC. Occurrence of infection among children with nephrotic syndrome during hospitalizations. Nephrol. 2012;17(8):681-8 .
Soeiro EM, Koch VH, Fujimura MD, Okay Y. Influence of nephrotic state on the infectious profile in childhood idiopathic nephrotic syndrome. Rev Hosp Clin Fac Med Sao Paulo. 2004;59(5):273-8.
Pais P, DA Eliis. Nephrotic syndrome, in Nelson textbook of Pediatrics, 19th edition,ed, Kleigman RM, Stanton BF, JW Geme, Schor NF, Behrman RE, Saunders Elsevir, New Delhi; 2012:1801-1806.
Alwadhi RK, Mathew JL, Rath B. Clinical profile of children with nephoitic syndrome not on glucocorticoid therapy, but presenting with infections. J Paediatr Child Health. 2004;40(1-2):28-32.
Hingorani SR, Weiss NS, Watkins SL. Predictors of peritonitis in children with nephrotic syndrome. Pediatr Nephrol. 2002;17(8):678-82.
Ljungberg P, Holmberg C, Jalanko H. Infections in infants with congenital nephrotic syndrome of finnish type. Pediatr Nephrol. 1997;11(2):14.
Safaei AA, Maleknejad S. Clinical and laboratory findings and therapeutic responses in children with nephrotic syndrome. Indian J Nephrol. 2010;20(2):68-71.
Bergstein JM. Nephrotic syndrome in Nelson textbook of Pediatrics 16th Edn. Eds Richard E. Behrman; 1999.
Kliegman RM, Jenson HB. W. B. Saunders Company; 2000:1592-1594.
Cameron JS. Clinical consequences of nephrotic syndrome. Adv Nephrol. 1988;17;157-72.
Cameron JS, Davison AM, Grunfeld JP, Kerr D, Ritz E (eds). Oxford university press; Oxford; 1992:276-97.
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.
Winberg J, Anderson HJ, Bergstrom T, Jacobssen B, Larson H, Lincoln K. Epidemiology of symptomatic urinary tract infection in childhood. Acta Pediatr Scand. 1974;63(suppl 252):1-20.
McVicar M, Policastro A, Gort D. The incidence ofurinary tract infection in nephrotic children. J Pediatr. 1973;82:166-7.
Ibadin MO. The prevalence of urinary tract infection in child hood nephrotic syndrome. Nigerian J Paediatr. 1997;24:40-4.
Coovadia HM, Adhikari M, Marogel L. Clinicopathological features of the nephrotic syndrome in South African children. Q J Med. 1979;48:77-91.
Eke FU. Nephrotic syndrome in Port-Harcourt. Clinical presentation and response to steroids. Nigerian J Paediatr. 1990;17:59-63.
Tsai YK, Chen CIT, Tsai WS, Sheu JN. Complications of nephrotic syndrome in children. J Formosa Med Assoc. 1991;90:555-9.
Obasaki MO, Erhabor EE. Trimethroprim - sulphamethoxazole resistance in Escherichia. Coliand Klebsiellaspp urinary isolates. Afr J Med Sci. 1998;17:133-40.
Adeleke SI, Asani MO, Belonwu RO, Ihesiolor GU. Urinary tract pathogens and antimicrobial sensitivity patterns in childhood urinary tract infection in Kano, Nigeria. Ann Niger Med. 2005;1:14-6.
Kala U, Milner LS, Lacobs D, Thomson PD. Impact of tuberculosis in children with idiopathic nephrotic syndrome. Pediatr Nephrol. 1993;7:392-5.
Goonasekera CDA, Shah V, Wade AM, Barrat TM, Dillon M. Fifteen years follow up of rennin and blood pressure in reflux nephropathy. Lancet. 1996;346:640-3.
Indian Pediatric nephrology group and Indian academy of paediatrics. Management of steroid sensitive nephrotic syndrome. Revised guidelines. Indian Pediatr. 2008;45:203-14.
Stokes EJ. Clinical bacteriology in: manual for tropical countries. Vol. II Microbiology Cambridge University Press; 1991:194-196.
Lawson D, Moncreiff AW, Payne WW. Forty years of nephrosis in childhood. Arch Dis Child. 1960;35:115-26.