Khemchand N Moorani.
Infections are common cause of relapse in children with nephrotic syndrome.
Pak Paed J Jan ;35(4):213-9.

Background: Infectious complications in nephrotic children may trigger the onset of disease or relapse so it is important to find out the magnitude and type of infection not only to treat but also to decrease relapse associated morbidity and mortality. Objective: To determine prevalence and type of infections in children with steroid-sensitive nephrotic syndrome (SSNS) and to document their association with relapse. Setting: Pediatric Nephrology, National Institute of Child Health, Karachi Study design and Duration: Descriptive case series, carried out from June 2005 to May 2010. Patients and Methods: Steroid-sensitive nephrotic children aged 6 months-14 years, followed-up over 5- years were studied. Demographic data including age and sex, response to steroid, number of relapses and type of infections, their association with the relapses was collected and analyzed using descriptive statistics on SPSS-13. Results: Among 720 children with SSNS, 367(50.97%) developed infectious episodes. Mean follow-up duration was 3.1 years. Mean age at initial diagnosis and present age was 5.4+2.7 and 7.99+3.12 years respectively. Of 367, 225(61.30%) were boys and 142(38.09%) girls. Majority of children (89%) were above 5 years. About 32.97% (121) had various infectious episodes at the onset of disease. All children had one or more episodes of relapses after initial remission and infections were responsible for relapses in 62.88% (283). Overall infection and relapse rate was 1.4 and one/patient/year respectively. Most common types of infections were acute respiratory infections (ARI), diarrhea and urinary tract infection (UTI) observed in 200(54.49%), 82(22.34%) and 30(8.17%) cases respectively. Other important infections were peritonitis (4.9%), skin infections (2.17%), chicken pox (1.36%) and pulmonary tuberculosis (0.81%). Conclusion: Infections are common complications (50.57%) in nephrotic children. ARI, diarrhoea and UTI were the most common infections. Overall infections were responsible for relapses in 62.88 % of cases.

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