Title: Hidden Urinary Tract Infection in Children with Nephrotic Syndrome
Authors: Rakesh Ranjan Kumar, Rizwan Ahmer
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.194
Abstract
Background: Urinary Tract Infection (UTI) is a common infection in nephrotic Syndrome. Most of UTI infection are asymptomatic and remains undiagnosed. This may leads to poor steroid response, frequent relapse and long term renal damage.
Methods: 50 case of nephrotic syndrome was diagnosed by clinical history and laboratory tests. Urine for Routine microscopic examination and culture –sensitivity was done in all patients. Data regarding proteinuria, pyuria and etiological organisms were analyzed by statistical method.
Results: UTI was present in 30% of nephrotic children and most cases (66.6%) were asymptomatic. Mean serum albumin in nephrotic syndrome with UTI was lower than that of children without UTI (2.1 gm/dl vs. 3gm/dl, P value<0.05 ) while mean serum cholesterol in nephrotic syndrome with UTI was higher than that of children without UTI (415 mg/dl Vs 350 mg/dl, p value < 0.05). Pyuria had poor association with definite UTI (p value > 0.05). E-coli were the commonest organism followed by klebsiella.
Conclusion: UTI is one of the most common infections in nephrotic syndrome and is mostly asymptomatic. It should be screened in every nephrotic child routinely to prevent long term renal damage.
Keywords: Nephrotic syndrome; UTI; microorganism.
References
1. Nanjundaswany HM, Phadke KD. Steroid sensitive Nephrotic syndrome. Indian J of Pediatr. 2002;69:1059-1063.
2. Consensus statement on management and audit potential for steroid responsive nephrotic syndrome : Report of a workshop by the British Association for Paediatric Nephrology and Research Unit, Royal College of Physicians. Arch Dis Child. 1994;70:151-157.
3. Gulati S, kher V, Arora A, et al. Urinary tract infection in nephrotic syndrome. Pediatr Infect Dis J. 1996;15:237-240.
4. Wolfish, P Melaine, P Philipps, et al. Role of respiratory viruses in exacerbations of primary nephrotic syndrome. The J of Pediatr. 1986;108: 378-382.
5. Alwadhi RK, Mathew JL, Rath B. Clinical profile of children with nephrotic syndrome not on glucocorticoid therapy but presenting with infection. J Paediatr Child Health. 2004;40:28-32.
6. George H and McCracken JR. Diagnosis and management of acute urinary tract infection in infants and children. The Pediatr Infect Dis J. 1987;6:107-112
7. Swash M. In : Hutchison’s Clinical Methods. London: W B Saunders. 1995;20:129-132.
8. Elder JS. Urinary tract infection. In: Kliegman, Behrman, Jenson, Stanton, editors. Nelson textbook of Pediatrics. Philadelphia: Kliegman Saunders. 2007;18:2223-2225.
9. Gulati S, Gupta A, Kher V, Sharma RK. Steroid response pattern in Indian children with nephrotic syndrome. Acta Paediatr. 1995;83:530-533
10. Senguttuvan P, Ravanan K, Pravu N, et al. Infection encountered in childhood nephrotics in a paediatric renal unit. Indian J Nephrol. 2004;14:85-88.
11. Gulati S, Arora P, Sharma RK, Kher V, Gupta A, Rai PK. Spectrum of Infections in Indian Children with Nephrotic Synd-rome. Pediatr Nephrol 1995;9:431-434.
12. Rahman M, Rahman KM. Urinary tract infection in school children. BMRC Bulletin. 1979;2:67-70.