How is the risk for infection managed during the treatment of proteinuria?

Updated: Mar 25, 2020
  • Author: Beje Thomas, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Patients with nephrotic syndrome are at increased risk of infection. The risk is greatest for bacterial infection (including spontaneous bacterial peritonitis) due to renal losses of immunoglobulin and complement components. No data, however, support the routine use of prophylactic antibiotics or immunoglobulin infusions.

Patients with nephrotic syndrome are at increased risk of infection. Both humoral and cell-mediated immunity are affected. Renal losses of immunoglobulin and complement, as well as a decrease in the number of circulating T lymphocytes, place nephrotic patients at a very high risk for bacterial infection, including spontaneous bacterial peritonitis. [34, 35]

The Advisory Committee on Immunization Practices (ACIP) recommends immunization with 13-valent pneumococcal conjugate vaccine (PCV13), followed by a dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 8 weeks later, in patients with nephrotic syndrome. A second dose of PPSV23 is given at least 5 years after the first. [36]


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