[Bacterial complications of nephrotic syndrome in children].
OBJECTIVE
Evaluate bacterial infection epidemiology and pathophysiology 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 when 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 infection concerned steroid-resistant nephrotic syndrome in 13 cases (41%), but only 7 out of them received immunosuppressive agents at the time of the infection. Eleven children (34%) experienced recurrent infections (1 to 6 recurrences), several of which under antibioprophylaxy. Half of the infections involved peritonitis and 50% of the identified germs 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 and justify a first-line antibiotherapy using a third generation cephalosporin. The presentation of severe bacterial infections show that it is less a iatrogenic event than a consequence of immunological disturbances induced by the nephrotic syndrome itself, as suggested by the acquired deficiency of factor I and B. Despite recent advances in antibiotic strategies responsible for a significant reduction in the severity of such infections (1 death among 32 patients), preventive treatments are quite disappointing.
Liponski
I
I
Unité de Néphrologie pédiatrique, Hôpital Edouard Herriot, Lyon.
Cochat
P
P
Gagnadoux
M F
MF
Parchoux
B
B
Niaudet
P
P
David
L
L
Broyer
M
M
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001424:Bacterial Infections / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D005260:Female; D005602:France; D006785:Hospitals, University; D006801:Humans; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D012008:Recurrence; D012189:Retrospective Studies
D000305:Adrenal Cortex Hormones; D002511:Cephalosporins
Complications bactériennes des néphroses chez l'enfant.