Abstract
A retrospective review (1970-1980) of 310 children with idiopathic nephrotic syndrome revealed 24 episodes of peritonitis in 19 patients (6.9 ± 3.7 years old). None were on cytotoxic drugs and only 64% were on steroids at the onset of peritonitis. All had proteinuria; 23 occurred during a relapse and one was at presentation of nephrosis. No morphologic subtype was at significantly greater risk for peritonitis. Abdominal pain, tenderness, edema, ascites, leukocytosis (22,300 ± 7,700 wbc/mm3) were universal. Other signs and symptoms included: fever (96%), anorexia (65%), vomiting (65%), diarrhea (52%), and abdominal wall cellulitis (22%); 17/19 had > 1000 wbc/mm3 of peritoneal fluid. Gram stain was positive in only 7/18. Organisms isolated included pneumococcus (13), E. coli (5), E. coli and B. fragilis (1-with appendicitis), and α-streptococcus (1); 4 were culture negative. Only 1/8 pneumococci typed is not included in the commercial vaccine (type 33). All pneumococci and E. coli were sensitive to all antibiotics routinely tested. Serum IgG levels in 13 episodes measured were dramatically reduced (116±77 mg%) compared to 43 control nephrotics (579±293; p < 0.001). Thus, peritonitis is still common in patients with nephrosis (6%); second episodes are frequent (26%); pneumococcus is the most frequent agent (54%) with 7/8 types represented in available vaccine. Patients in relapse, with ascites, edema, and severe hypogammaglobulinemia appear at greatest risk.
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Krensky, A., Grupe, W. & Ingelfinger, J. 1513 PERITONITIS IN CHILDHOOD NEPHROTIC SYNDROME. Pediatr Res 15 (Suppl 4), 695 (1981). https://doi.org/10.1203/00006450-198104001-01536
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DOI: https://doi.org/10.1203/00006450-198104001-01536