Strategies for Prevention of Infection in Nephrotic Children Prevention of Infection in Nephrotic Children
Journal of Pediatric Nephrology,
Vol. 9 No. 1 (2021),
3 January 2021
,
Page 1-9
https://doi.org/10.22037/jpn.v9i1.32477
Abstract
Children with nephrotic syndrome (NS) develop complications due to either the disease state or its treatment. Infections, thromboembolism and acute kidney injury are the most common complications in children with NS. Several studies in children with NS have reported that urinary tract infections, upper respiratory tract infections, peritonitis and sepsis are the most commonly reported infections. Infection is one of the common triggering factors for relapse, and prophylaxis against infections is required in patients unresponsive to steroids or with frequently relapsing disease. In this review article, we summarize the strategies for prevention of infections in NS. The most commonly studied drug for the prevention of infection in NS is intravenous immunoglobulin G (IVIg), while other drugs include thymosin, oral transfer factor, Bacillus Calmette-Guérin (BCG) vaccine, mannan peptide tablet, polyvalent bacterial vaccine and Chinese herbal medications (Tiaojining and Huangqui granules). Several vaccination programs including pneumococcal, influenza A, varicella and measles have been effective in the prevention of infections in nephrotic children. However, established measures for preventing infections in nephrotic children are lacking, and to draw any conclusion, randomized controlled trials are required.
Keywords:
- Nephrotic syndrome
- prevention
- infection
- children
How to Cite
1.
Pradhan SK, Nayak S, Priyadarshini L. Strategies for Prevention of Infection in Nephrotic Children: Prevention of Infection in Nephrotic Children. J Ped Nephrol [Internet]. 2020 Oct. 28 [cited 2025 Jan. 13];9(1):1-9. Available from: https://journals.sbmu.ac.ir/jpn/article/view/32477
References
1. Hunley T, Yared A, Fogo A, et al. Nephrotic syndrome in an adolescent: The cry of the wolf. American Journal of Kidney Diseases. 1998;31(1):155-160.
2. Pasini A, Benetti E, Conti G, et al. The Italian Society for Pediatric Nephrology (SINePe) consensus document on the management of nephrotic syndrome in children: Part I - Diagnosis and treatment of the first episode and the first relapse. Italian Journal of Pediatrics. 2017;43(1):41.
3. Trompeter RS, Lloyd BW, Hicks J, et al. Long-term outcome for children with minimal-change nephrotic syndrome. Lancet. 1985;1(8425):368-370.
4. Park SJ, Shin JI. Complications of nephrotic syndrome. Korean journal of pediatrics. 2011;54(8):322-328.
5. Rheault MN, Wei C-C, Hains DS, et al. Increasing frequency of acute kidney injury amongst children hospitalized with nephrotic syndrome. Pediatric nephrology (Berlin, Germany). 2014;29(1):139-147.
6. Kumar M, Ghunawat J, Saikia D, et al. Incidence and risk factors for major infections in hospitalized children with nephrotic syndrome. J Bras Nefrol. 2019;41(4):526-533.
7. Soeiro EMD, Koch VH, Fujimura MD, et al. Influence of nephrotic state on the infectious profile in childhood idiopathic nephrotic syndrome. Revista do Hospital das Clínicas. 2004;59(273-278.
8. Ram S, Lewis LA, Rice PA. Infections of people with complement deficiencies and patients who have undergone splenectomy. Clinical microbiology reviews. 2010;23(4):740-780.
9. Gulati S, Kher V, Gupta A, et al. Spectrum of infections in Indian children with nephrotic syndrome. Pediatr Nephrol. 1995;9(4):431-434.
10. Mattoo TK, Mahmoud MA. Increased maintenance corticosteroids during upper respiratory infection decrease the risk of relapse in nephrotic syndrome. Nephron. 2000;85(4):343-345.
11. Moorani KN, Khan KM, Ramzan A. Infections in children with nephrotic syndrome. J Coll Physicians Surg Pak. 2003;13(6):337-339.
12. Krishnan C, Rajesh TV, Shashidhara HJ, et al. Major infections in children with nephrotic syndrome. International Journal of Contemporary Pediatrics. 2017;4(346-350.
13. WEI CC, YU IW, LIN HW, et al. Occurrence of infection among children with nephrotic syndrome during hospitalizations. Nephrology. 2012;17(8):681-688.
14. Alfakeekh K, Azar M, Sowailmi BA, et al. Immunosuppressive burden and risk factors of infection in primary childhood nephrotic syndrome. J Infect Public Health. 2019;12(1):90-94.
15. Liponski I, Cochat P, Gagnadoux MF, et al. [Bacterial complications of nephrotic syndrome in children]. Presse Med. 1995;24(1):19-22.
16. Lin JN, Lin CL, Yang CH, et al. Risk of Nephrotic Syndrome following Enteroviral Infection in Children: A Nationwide Retrospective Cohort Study. PLoS One. 2016;11(8):e0161004.
17. McCaffrey J, Lennon R, Webb NJA. The non-immunosuppressive management of childhood nephrotic syndrome. Pediatric Nephrology. 2016;31(9):1383-1402.
18. Indian Pediatric Nephrology Group, Indian Academy of Pediatrics. Consensus Statement on Management of Steroid Sensitive Nephrotic Syndrome. Indian Pediatrics 2001; 38: 975-986.
19. Ogi M, Yokoyama H, Tomosugi N, et al. Risk Factors for Infection and Immunoglobulin Replacement Therapy in Adult Nephrotic Syndrome. American Journal of Kidney Diseases. 1994;24(3):427-436.
20. Sarker M, Islam M, Saad T, et al. Risk factor for relapse in childhood nephrotic syndrome-a hospital based retrospective study. Faridpur Medical College Journal. 2012;7(1):18-22.
21. Bagga A. Revised guidelines for management of steroid-sensitive nephrotic syndrome. Indian journal of nephrology. 2008;18(1):31-39.
22. Shroff A, Frank R, Vergara M, et al. Prevention of serious bacterial infections in new-onset nephrotic syndrome: a survey of current practices. Clin Pediatr (Phila). 2002;41(1):47-49.
23. McINTYRE P, CRAIG J. Prevention of serious bacterial infection in children with nephrotic syndrome. Journal of Paediatrics and Child Health. 1998;34(4):314-317.
24. Wu HM, Tang JL, Cao L, et al. Interventions for preventing infection in nephrotic syndrome. Cochrane Database of Systematic Reviews. 2012;4):
25. Dang X, Yi Z, Wang X, et al. Preventive efficiency of IVIgG on nosocomial infection in the children with nephrotic syndrome. Hunan yi ke da xue xue bao= Hunan Yike Daxue Xuebao= Bulletin of Hunan Medical University. 1999;24(3):290-292.
26. Wu Q, Wu X. Clinical study of gammaglobulin on upper respiratory infection prevention in nephrotic syndrome children. Journal of Hainan Medical College. 2009;15(8):879-880.
27. Dou ZY, Wang JY, Liu YP. Preventive efficiency of low‐dose IVIgG on infection in nephrotic syndrome. Chinese Journal of Biologicals 2000;13(3):160.
28. Tong LZ, Mi LZ. Preventive efficiency of IVIgG on secondary nosocomial infection in nephrotic syndrome. Modern Rehabilitation 1998;2(3):236.
29. Zhang YJ, Wang Y, Yang ZW, Li XT. Thymosin for the prevention of infection in children with the idiopathic nephrotic syndrome. Chinese Journal of Contemporary Pediatrics 2000;2(3):197‐9.
30. Krishnaveni M. A review on transfer factor an immune modulator. drug invention today. 2013;5(153-156.
31. Berrón-Pérez R, Chávez-Sánchez R, Estrada-García I, et al. Indications, usage, and dosage of the transfer factor. Revista Alergia de Mexico. 2007;54(4):
32. Rao XZ. Preventive effect of oral transferin factor on secondary infection in children with simple nephrotic syndrome. Chinese Journal of Coal Industry Medicine 2005;8 (3):270.
33. Nelson RD, Shibata N, Podzorski RP, et al. Candida mannan: chemistry, suppression of cell-mediated immunity, and possible mechanisms of action. Clinical microbiology reviews. 1991;4(1):1-19.
34. Guo YC, Cheng YY, Zhang LH. Preventive effects of secondary Infection on children simple nephrotic syndrome by mannan peptide. Chinese JournaI of MedicinaI Guide 2008;10(5):715–6.
35. Kang GG. Preventive effect of complicated infection of children with nephrotic syndrome on vaccine injection. Chinese Pediatric Emergency Medicine 2003;10(5):299–301.
36. Ye QB, Huang T, Li ZH,Wang YQ. The clinical research on using polyvalent bacterial vaccine to prevent the nosocomial infection of children with primary nephritic syndrome. Applied Journal of General Practice 2004;12(2):132–4.
37. Li RH, Peng ZP, Wei YL, Liu CH. Clinical observation on Chinese medicinal herbs combined with prednisone for reducing the risks of infection in children with nephrotic syndrome. Information Journal of Chinese Medicine 2000;7(10):60–1.
38. Chen J, Chen SQ. Preventive effects of Huangqi on infection in children with nephrotic syndrome. Zhong Guo Zhong Xi Yi Jie He Za Zhi [Chinese Journal of Integrated Traditional and Western Medicine] 2008;28(5):467–9.
39. Kang GG. Preventive effects of Huangqi on secondary infection in children with simple nephrotic syndrome. Chinese Journal of Integrated Traditional and Western Nephrology 2005;6(12):718–9.
40. Cameron JS. The nephrotic syndrome and its complications. Am J Kidney Dis. 1987;10(3):157-171.
41. Gipson DS, Massengill SF, Yao L, et al. Management of childhood onset nephrotic syndrome. Pediatrics. 2009;124(2):747-757.
42. Haute Autorite de Sante. Syndrome nephrotique idiopathique de l’enfant: protocole national de diagnostic et de soins pour une maladie rare. 2008. Available at: http://www.has-sante.fr/portail/upload/docs/application/pdf/2008-06/pnds_sni_enfant.pdf.
43. The Royal Children's Hospital Melbourne. Clinical Practice Guidelines. Nephrotic syndrom. Available at https://www.rch.org.au/clinicalguide/guideline_index/Nephrotic_syndrome/.
44. Milner LS, Berkowitz FE, Ngwenya E, et al. Penicillin resistant pneumococcal peritonitis in nephrotic syndrome. Arch Dis Child. 1987;62(9):964-965.
45. Sawyer MH. AAP expands recommendations for use of pneumococcal conjugate vaccine. AAP News. 2014;35(12):16-16.
46. Department of Health (Public Health England). Immunisation against infectious disease. 2013. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/266583/The_Green_book_front_cover_and_contents_page_December_2013.pdf
47. Alpay H, Yildiz N, Onar A, et al. Varicella vaccination in children with steroid-sensitive nephrotic syndrome. Pediatr Nephrol. 2002;17(3):181-183.
48. Macfarlane GT, Cummings JH. Probiotics, infection and immunity. Curr Opin Infect Dis. 2002;15(5):501-506.
49. Amara AA, Shibl A. Role of Probiotics in health improvement, infection control and disease treatment and management. Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society. 2015;23(2):107-114.
50. Aiba Y, Suzuki N, Kabir AM, et al. Lactic acid-mediated suppression of Helicobacter pylori by the oral administration of Lactobacillus salivarius as a probiotic in a gnotobiotic murine model. Am J Gastroenterol. 1998;93(11):2097-2101.
2. Pasini A, Benetti E, Conti G, et al. The Italian Society for Pediatric Nephrology (SINePe) consensus document on the management of nephrotic syndrome in children: Part I - Diagnosis and treatment of the first episode and the first relapse. Italian Journal of Pediatrics. 2017;43(1):41.
3. Trompeter RS, Lloyd BW, Hicks J, et al. Long-term outcome for children with minimal-change nephrotic syndrome. Lancet. 1985;1(8425):368-370.
4. Park SJ, Shin JI. Complications of nephrotic syndrome. Korean journal of pediatrics. 2011;54(8):322-328.
5. Rheault MN, Wei C-C, Hains DS, et al. Increasing frequency of acute kidney injury amongst children hospitalized with nephrotic syndrome. Pediatric nephrology (Berlin, Germany). 2014;29(1):139-147.
6. Kumar M, Ghunawat J, Saikia D, et al. Incidence and risk factors for major infections in hospitalized children with nephrotic syndrome. J Bras Nefrol. 2019;41(4):526-533.
7. Soeiro EMD, Koch VH, Fujimura MD, et al. Influence of nephrotic state on the infectious profile in childhood idiopathic nephrotic syndrome. Revista do Hospital das Clínicas. 2004;59(273-278.
8. Ram S, Lewis LA, Rice PA. Infections of people with complement deficiencies and patients who have undergone splenectomy. Clinical microbiology reviews. 2010;23(4):740-780.
9. Gulati S, Kher V, Gupta A, et al. Spectrum of infections in Indian children with nephrotic syndrome. Pediatr Nephrol. 1995;9(4):431-434.
10. Mattoo TK, Mahmoud MA. Increased maintenance corticosteroids during upper respiratory infection decrease the risk of relapse in nephrotic syndrome. Nephron. 2000;85(4):343-345.
11. Moorani KN, Khan KM, Ramzan A. Infections in children with nephrotic syndrome. J Coll Physicians Surg Pak. 2003;13(6):337-339.
12. Krishnan C, Rajesh TV, Shashidhara HJ, et al. Major infections in children with nephrotic syndrome. International Journal of Contemporary Pediatrics. 2017;4(346-350.
13. WEI CC, YU IW, LIN HW, et al. Occurrence of infection among children with nephrotic syndrome during hospitalizations. Nephrology. 2012;17(8):681-688.
14. Alfakeekh K, Azar M, Sowailmi BA, et al. Immunosuppressive burden and risk factors of infection in primary childhood nephrotic syndrome. J Infect Public Health. 2019;12(1):90-94.
15. Liponski I, Cochat P, Gagnadoux MF, et al. [Bacterial complications of nephrotic syndrome in children]. Presse Med. 1995;24(1):19-22.
16. Lin JN, Lin CL, Yang CH, et al. Risk of Nephrotic Syndrome following Enteroviral Infection in Children: A Nationwide Retrospective Cohort Study. PLoS One. 2016;11(8):e0161004.
17. McCaffrey J, Lennon R, Webb NJA. The non-immunosuppressive management of childhood nephrotic syndrome. Pediatric Nephrology. 2016;31(9):1383-1402.
18. Indian Pediatric Nephrology Group, Indian Academy of Pediatrics. Consensus Statement on Management of Steroid Sensitive Nephrotic Syndrome. Indian Pediatrics 2001; 38: 975-986.
19. Ogi M, Yokoyama H, Tomosugi N, et al. Risk Factors for Infection and Immunoglobulin Replacement Therapy in Adult Nephrotic Syndrome. American Journal of Kidney Diseases. 1994;24(3):427-436.
20. Sarker M, Islam M, Saad T, et al. Risk factor for relapse in childhood nephrotic syndrome-a hospital based retrospective study. Faridpur Medical College Journal. 2012;7(1):18-22.
21. Bagga A. Revised guidelines for management of steroid-sensitive nephrotic syndrome. Indian journal of nephrology. 2008;18(1):31-39.
22. Shroff A, Frank R, Vergara M, et al. Prevention of serious bacterial infections in new-onset nephrotic syndrome: a survey of current practices. Clin Pediatr (Phila). 2002;41(1):47-49.
23. McINTYRE P, CRAIG J. Prevention of serious bacterial infection in children with nephrotic syndrome. Journal of Paediatrics and Child Health. 1998;34(4):314-317.
24. Wu HM, Tang JL, Cao L, et al. Interventions for preventing infection in nephrotic syndrome. Cochrane Database of Systematic Reviews. 2012;4):
25. Dang X, Yi Z, Wang X, et al. Preventive efficiency of IVIgG on nosocomial infection in the children with nephrotic syndrome. Hunan yi ke da xue xue bao= Hunan Yike Daxue Xuebao= Bulletin of Hunan Medical University. 1999;24(3):290-292.
26. Wu Q, Wu X. Clinical study of gammaglobulin on upper respiratory infection prevention in nephrotic syndrome children. Journal of Hainan Medical College. 2009;15(8):879-880.
27. Dou ZY, Wang JY, Liu YP. Preventive efficiency of low‐dose IVIgG on infection in nephrotic syndrome. Chinese Journal of Biologicals 2000;13(3):160.
28. Tong LZ, Mi LZ. Preventive efficiency of IVIgG on secondary nosocomial infection in nephrotic syndrome. Modern Rehabilitation 1998;2(3):236.
29. Zhang YJ, Wang Y, Yang ZW, Li XT. Thymosin for the prevention of infection in children with the idiopathic nephrotic syndrome. Chinese Journal of Contemporary Pediatrics 2000;2(3):197‐9.
30. Krishnaveni M. A review on transfer factor an immune modulator. drug invention today. 2013;5(153-156.
31. Berrón-Pérez R, Chávez-Sánchez R, Estrada-García I, et al. Indications, usage, and dosage of the transfer factor. Revista Alergia de Mexico. 2007;54(4):
32. Rao XZ. Preventive effect of oral transferin factor on secondary infection in children with simple nephrotic syndrome. Chinese Journal of Coal Industry Medicine 2005;8 (3):270.
33. Nelson RD, Shibata N, Podzorski RP, et al. Candida mannan: chemistry, suppression of cell-mediated immunity, and possible mechanisms of action. Clinical microbiology reviews. 1991;4(1):1-19.
34. Guo YC, Cheng YY, Zhang LH. Preventive effects of secondary Infection on children simple nephrotic syndrome by mannan peptide. Chinese JournaI of MedicinaI Guide 2008;10(5):715–6.
35. Kang GG. Preventive effect of complicated infection of children with nephrotic syndrome on vaccine injection. Chinese Pediatric Emergency Medicine 2003;10(5):299–301.
36. Ye QB, Huang T, Li ZH,Wang YQ. The clinical research on using polyvalent bacterial vaccine to prevent the nosocomial infection of children with primary nephritic syndrome. Applied Journal of General Practice 2004;12(2):132–4.
37. Li RH, Peng ZP, Wei YL, Liu CH. Clinical observation on Chinese medicinal herbs combined with prednisone for reducing the risks of infection in children with nephrotic syndrome. Information Journal of Chinese Medicine 2000;7(10):60–1.
38. Chen J, Chen SQ. Preventive effects of Huangqi on infection in children with nephrotic syndrome. Zhong Guo Zhong Xi Yi Jie He Za Zhi [Chinese Journal of Integrated Traditional and Western Medicine] 2008;28(5):467–9.
39. Kang GG. Preventive effects of Huangqi on secondary infection in children with simple nephrotic syndrome. Chinese Journal of Integrated Traditional and Western Nephrology 2005;6(12):718–9.
40. Cameron JS. The nephrotic syndrome and its complications. Am J Kidney Dis. 1987;10(3):157-171.
41. Gipson DS, Massengill SF, Yao L, et al. Management of childhood onset nephrotic syndrome. Pediatrics. 2009;124(2):747-757.
42. Haute Autorite de Sante. Syndrome nephrotique idiopathique de l’enfant: protocole national de diagnostic et de soins pour une maladie rare. 2008. Available at: http://www.has-sante.fr/portail/upload/docs/application/pdf/2008-06/pnds_sni_enfant.pdf.
43. The Royal Children's Hospital Melbourne. Clinical Practice Guidelines. Nephrotic syndrom. Available at https://www.rch.org.au/clinicalguide/guideline_index/Nephrotic_syndrome/.
44. Milner LS, Berkowitz FE, Ngwenya E, et al. Penicillin resistant pneumococcal peritonitis in nephrotic syndrome. Arch Dis Child. 1987;62(9):964-965.
45. Sawyer MH. AAP expands recommendations for use of pneumococcal conjugate vaccine. AAP News. 2014;35(12):16-16.
46. Department of Health (Public Health England). Immunisation against infectious disease. 2013. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/266583/The_Green_book_front_cover_and_contents_page_December_2013.pdf
47. Alpay H, Yildiz N, Onar A, et al. Varicella vaccination in children with steroid-sensitive nephrotic syndrome. Pediatr Nephrol. 2002;17(3):181-183.
48. Macfarlane GT, Cummings JH. Probiotics, infection and immunity. Curr Opin Infect Dis. 2002;15(5):501-506.
49. Amara AA, Shibl A. Role of Probiotics in health improvement, infection control and disease treatment and management. Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society. 2015;23(2):107-114.
50. Aiba Y, Suzuki N, Kabir AM, et al. Lactic acid-mediated suppression of Helicobacter pylori by the oral administration of Lactobacillus salivarius as a probiotic in a gnotobiotic murine model. Am J Gastroenterol. 1998;93(11):2097-2101.
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