Major infections in children with nephrotic syndrome

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


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.


Children, Major infections, Nephrotic syndrome, Peritonitis, Septicemia

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