What is the role of vaccines in the treatment of pediatric nephrotic syndrome?

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

Yearly influenza vaccination is recommended to prevent serious illness in the immunocompromised patient, as well as to prevent this possible trigger of relapse.

Pneumococcal vaccination (23-valent and heptavalent) should be administered to all patients with INS upon presentation. Vaccination should be repeated every 5 years while the patient continues to have relapses.

Routine childhood vaccines with live virus strains are contraindicated during steroid therapy and for a minimum of 1 month afterward. [103] Care must be taken in administering live viral vaccines to children in remission from FRNS, who might need to restart steroid therapy shortly after vaccination.

Because of the high risk of varicella infection in the immunocompromised patient, postexposure prophylaxis with varicella-zoster immune globulin is recommended in the nonimmune patient. Patients with varicella-zoster infection should be treated with acyclovir and carefully monitored. [41] Varicella immunization is safe and effective in patients with INS who are in remission and off steroid treatment (with the usual precautions for administering live viral vaccines to patients who have received steroids). [104]

Routine non-live viral vaccines should be administered according to their recommended schedules. Although it was formerly believed that routine immunization can trigger a relapse of nephrotic syndrome, no solid evidence supports this belief, and the risk of preventable childhood illnesses exceeds the theoretical, unproven risk of triggering relapses.


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