BACTERIAL-INFECTIONS IN THE NEPHROTIC SYN DROME DURING CHILDHOOD

Objectives: Evaluate bacterial infection epidemiology and pathophysiol ogy in children with nephrotic syndrome. Methods: From January 1983 to December 1992, 399 children with the nephrotic syndrome were admitted in 3 University Pediatric wards (Paris Enfants Malades, Lyon Edouard Herriot, Lyon Debrousse). Severe bacterial infection was diagnosed whe n the patient's condition has justified an intravenous antibiotherapy. Results: Forty-eight bacterial infections were noted in 32 patients ( 8%); the infection was the first symptom of the disease in 10 patients (31%); one patient died shortly after admission, Severe bacterial inf ection concerned steroid-resistant nephrotic syndrome in 13 cases (41% ), but only 7 out of them received immunosupressive agents at the time of the infection. Eleven children (34%) experienced recurrent infecti ons (1 to 6 recurrences), several of which under antibioprophylaxy, Ha lf of the infections involved peritonitis and 50% of the identified ge rms were S. pneumoniae. However, peritonitis was not always related to S. pneumoniae (1 H. influenzae among 9 identified germs). Conclusions : These data demonstrate the importance of microbiological sampling an d justify a first-line antibiotherapy using a third generation cephalo sporin. The presentation of severe bacterial infections show that it i s less a iatrogenic event than a consequence of immunological disturba nces induced by the nephrotic syndrome itself, as suggested by the acq uired deficiency of factor I and B. Despite recent advances in antibio tic strategies responsible for a significant reduction in the severity of such infections (1 death among 32 patients), preventive treatments are quite disappointing,