Urinary tract infection at presentation of nephrotic syndrome: A clinical evaluation

Abstract

Aims: The aim was to study the incidence, etiology, clinical features and the antibiotic sensitivity pattern of urinary tract infections (UTI) in children at presentation of nephrotic syndrome (NS) (first or recurrent episodes before starting immunosuppressive therapy). Methods: This was a prospective hospital-based study carried out in Basaveshwara hospital, Chitradurga. Fifty children with a diagnosis of NS were studied from June 2010 to October 2014. The cases with recurrence of NS or those with the first episode of NS were evaluated before placing on immunosuppressive therapy. A clean-catch midstream urine specimen was collected from all children to avoid contamination. For younger children, where collection of urine was difficult in the manner described above, suprapubic aspiration was done. Prompt plating of the urine specimen, within 1-h of a collection, was ensured. Identification of the organism and antibiotic sensitivity patterns was determined.
Results: Among the fifty children studied, boys were affected more than the girls with a ratio of 1.5:1. The mean age was 4.75 years. Pyuria was noted in 64% of the patients. The most common organism isolated was Escherichia coli in 10 cases, followed by Klebsiella pneumoniae in 4 cases. About 75% of the organisms were sensitive to third-generation cephalosporins. Conclusions: UTI is a common infection accompanying NS. A high index of suspicion and early institution of appropriate antibiotics will help in attenuating morbidity and mortality.