Urinary Tract Infection in Children with Idiopathic Nephrotic Syndrome

Abstract

Nephrotic syndrome is a common childhood kidney disorder featured by increase protein excretion urine with low serum albumin with generalized edema and hyperlipidemia. It’s mainly a disease of childhood 15 times more than an adult. The occurrence of Urinary tract infection (UTI) in these patients is increasing, this may be to immunoglobulin loss in urine, defective T cell function, immune-suppressive agents, and relative malnutrition.
Aim of the Study: It is to evaluate the occurrence of UTI, its etiological agents, antibiotics sensitivity type, and the effect of UTI on relapse and response to therapy in children with nephrotic syndrome in An Najaf Governorate.
Methods: A prospective cross-sectional study of all patients with idiopathic nephrotic syndrome from January 2018 to January 2019 visiting nephrology unit in Al Sader teaching hospital and Al Zahraa teaching hospital. The urine sample was taken by a clean catch method of midstream urine and by urine bag methods for those under 3 years old. The specimens were cultured immediately then examined under the microscope.
Results: 101 patients were studied. The mean age and (S.D) for males was 6.3±2.35years and females with 6.5±1.9years. The age range was 1.5 year to 10 years. There were 44 patients (43.6%) had UTI, 29 patients (65.9%) of them were males, and 15 patients (34.1%) females. UTI caused by E. coli. in (25) patients ( 58%) ,Streptococcus (8) patients(16.26%), Staphylococcus aureus (5) patients (11.36%), Proteus (3) patients(6.97%), Pseudomonas (2) patients (4.65%), Klebsiella species (1) patients (2.32%). The E.coli show very good antibiotic sensitivity to cefatriaxion, cefataxime and ciprofloxacin. Each of Proteus, Klebsiella, Pseudomonas spp. show good sensitivity to cefatriaxion, ciprofloxacin and aminoglycoside while each of Streptococcus SPP and Staphylococcus aureus show good response to ciprofloxacin and moderate sensitivity to the augmentine (a combination of amoxicillin and clavulanic acid) and to Septrin (co-trimoxazole) (combinations of Sulfamethoxazole and trimethoprim) and there was high in vitro resistance of these bacteria to ampicillin and nalidixic acid.
Conclusion: There is a high occurrence of urinary tract infection in idiopathic nephrotic syndrome children of An Najaf Al Ashraf city and its necessity to diagnose the disease early depending on clinical suspicion and doing the GUE and cultures monthly to avoid delay in diagnosis of infections and their sequels.