Why is the risk of infection increased in patients with pediatric nephrotic syndrome?

Updated: Mar 04, 2020
  • Author: Jerome C Lane, MD; Chief Editor: Craig B Langman, MD  more...
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Answer

Patients with INS are at increased risk for infection. Peritonitis and sepsis are the most common and serious infections. Peritonitis occurs at a rate of approximately 2-6% and may be accompanied by sepsis or bacteremia. The predominant bacterial causes are Streptococcus pneumoniae and Gram-negative enteric organisms such as Escherichia coli. [39]

Various infections can also occur, including meningitis, cellulitis, viral infections, and others. Varicella is a particular concern in immunosuppressed patients and can be lethal. Prompt recognition and treatment with acyclovir (or postexposure prophylaxis with varicella-zoster immune globulin [VZIG]) is essential. Routine childhood varicella immunization has alleviated some of the concern regarding this complication.

Infection, viral or bacterial, can trigger relapse of INS and further complicate the course of the condition.

Risk of infection may be increased in INS because of low immunoglobulin (Ig) G levels, which do not appear to be the result of urinary losses. Instead, low IgG levels seem to be the result of impaired synthesis, again pointing to a primary disorder in lymphocyte regulation in INS.

Additionally, increased urinary losses of factor B are noted. This is a cofactor of C3b in the alternative pathway of complement, which plays an important role in the opsonization of encapsulated organisms such as S pneumoniae. Impaired T-cell function may also be present in INS, which contributes to the susceptibility to infection. Finally, the medications used to treat INS, such as corticosteroids and alkylating agents, further suppress the immune system and increase the risk of infection. [1]


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