Urinary Tract Infections In Pediatric Patients With Nephrotic Syndrome

Abstract

Background : Children who are regularly hospitalised are at an elevated risk of acquiring various infections that may exacerbate their already precarious health conditions.  Previous investigations have delineated the broad clinical range and the incidence of severe infections, including Urinary Tract Infection (UTI), pneumonia, septicaemia, peritonitis, and skin or soft tissue infections, particularly in nephrotic children.

Aim : To examine the correlation between urinary tract infections (UTI) and nephrotic syndrome in paediatric patients.

Materials And Methods: The study comprised a sample of 53 children with nephrotic syndrome, easily picked from AL-Kadhimiya Teaching Hospital and AL-Fallujah Teaching Hospital in Baghdad.  A study was conducted using a convenience sampling technique involving individuals with nephrotic syndrome who attended routine appointments or sought medical assistance and consented to participate in the research.

Results : Sixty-six percent of the patients lived in urban regions, whereas thirty-four percent resided in rural settings, indicating that urban youngsters may be more susceptible to specific risk factors or have superior access to healthcare services that facilitate identification.  The average age was 7 ± 3.43 years; fever was observed in 12.5% of patients, whilst cloudy urine was noted in 7.3%.  This distribution reveals that irritative urinary symptoms are the primary characteristics in this cohort, while systemic indications such as fever and observable urine alterations are less prevalent. Among the total male patients, 7 (21.9%) exhibited a positive culture, while 25 (78.1%) demonstrated a negative culture.  Among the female patients, 6 (28.6%) exhibited a positive culture, while 15 (71.4%) demonstrated a negative culture. In the age category of 1-5 years, 5 patients (22.7%) exhibited a positive culture, while 17 patients (77.3%) demonstrated a negative culture. In the 6-11 year age range, 5 individuals (22.7%) exhibited a positive culture, while 14 individuals (77.3%) had a negative culture. Among individuals aged 12 years and older, 3 (33.3%) exhibited a positive culture, while 6 (66.7%) had a negative culture.  The study has a total of 53 patients, comprising 13 with positive cultures and 40 with negative cultures.  The positive culture rate is 24.5%, signifying that 24.5% of patients had a positive urine culture result.  The negative culture rate is 75.5%, indicating that the majority of patients (75.5%) did not yield a positive culture result. All 13 individuals with positive cultures (100%) had E. coli identified as the causative organism of the infection.  This indicates that E. coli is the exclusive causal agent of urinary tract infections (UTIs) in this group of patients with nephrotic syndrome. Given that E. coli was found in 100% of positive cultures, a comprehensive analysis might investigate potential associations between the presence of E. coli and other clinical factors (e.g., severity of nephrotic syndrome, treatment regimen, etc.). Pus Cells ≤ 5: 23.1% (positive culture) compared to 65% (negative culture).  Pus cells exceeding 5: 76.9% (positive culture) compared to 35% (negative culture). The notable correlation between pus cells (>5) and positive culture results (P-value = 0.007) highlights the diagnostic significance of urine examination for pus cells in detecting UTIs.

Conclusion:The investigation uncovered an anomalous sex distribution, indicating that a greater proportion of male paediatric patients (60.4%) experienced UTIs compared to girls (39.6%), despite the typical prevalence of UTIs being higher in females.  Sixty-six percent of the patients were from metropolitan regions, indicating that improved healthcare access may affect UTI diagnosis.  The average age of affected children was 7 ± 3.43 years, predominantly impacting those in early school age, potentially driven by behavioural problems and difficulties with toilet training.