Infections in Indian Children with Nephrotic Syndrome

Back ground: Children with nephrotic syndrome are susceptible to different types of infections. However, the only causes for the infection reported to date are bacteria and prior reported series did not identify fungi as causative organism.

Methods: A retrospective study of 2912 children with nephrotic syndrome was made to determine the demography, incidence of infections and bacterial and fungal etiologies.

Results: Between January 2000 and August 2017, we identified that 29.60% of the children developed infections. The prevalence of bacterial and fungal infections in urinary tract is 42.11% and 8.01%, in lower respiratory tract 22.15% and 6.14%, in upper respiratory tract 12.65% and 1.62%, in diarrhoea 1.62% and 0.35%, in septicaemia 0.93% and 0.24% and in peritonitis 1.62% and 0.24% respectively. In skin lesions, 0.81% fungal presence was detected while in meningitis, tuberculosis and enteric fever 0.23%, 0.58% and 0.70% respectively with no traces of fungi. Statistical analysis was performed for biochemical indices and infections and was found significant for low serum albumin and high serum cholesterol (p<0.05).

Conclusions: Thus, the present study clearly states that infections are important but are often under diagnosed in children with Nephrotic syndrome because steroid is anti inflammatory so classical symptoms of infections may not be noticed. Therefore, children suffering with nephrotic syndrome in relapse or those exhibiting steroid resistant should be screened for the presence of various infections. During screening, apart from the bacterial etiology, it is important to consider fungal etiology as well.

Keywords: Nephrotic syndrome, Children, Infection, Bacteria, Fungus.