Nephrotic Syndrome and UTI - Pediatric Oncall

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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	Specialist Answers
Question
A 3 year old male child presented with c/o generalized swelling of the body and scanty urine for 1 week. No past h/o sore throat or pyoderma. o/e anasaeca,bp 98/52.cvs,R/s,gi,cns normal. urinalysis: protien +++,puscells 10-15,Rbc occassional/h.p.f.,coarse granular casts++ Hb. 9.2gm,TLC : 10800,P 64,L33,E -3%. ESR:77mm/1st. hr. Bun 22,se creatinine 0.7,se cholestrol :438,Total proteins : 5g, albumen 2.6g. Urine culture: Klebsiella (Sig.) S : Amikacin,Nitrofurantoin,gentamycin. Ultrasound scan of KUB : NAD Mx. test negative,Xray chest normal. This child was diagnosed as Nephrotic syndrome and UTI. He was given Inj Amkacin x 10 days and put on Prednisolone 2mg/kg/d. His urinary flow increased and proteinuria subsided to + but pus cells were still 6-8/hpf.and urine culture continued to be positive on 3 weekly repetitions. Repeat ESR 42mm and se cholestrol ;370 after 4 weeks of steroids. After mikacin he was put on furadantin 6mg/kg/day for 2 weeks and then on 2mgS/kg/day;on which he is still continued to combat a chronic UTI. The query is: 1.Is the UTI persisting because of steroid therapy? 2.Should steroids be discontinued and restarted after urine culture is sterile on at least 2 repetitions? Dr. J.S. Chugh Consultant Paediatrician S.N.S PAHWA HOSPITAL IND. AREA-B, LUDHIANA(Pb.)
Answer
One must quantify the growth of the organism in the urine culture. It should be more than 100000 colonies for it to be significant. If the growth is significant, then treat the infection first and then start treatment for nephrotic syndrome once the infection is under control. In a child who is already on steroids, treat the infection and taper of the steroids. Once infection is cured, reintroduce the steroids and treat with full ISKDC regime right from beginning. Back to All Questions

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