Role of urinary tract infections as triggers for frequent relapse in children with steroid sensitive nephrotic syndrome

Abstract

Frequent relapse occurs in about 60% of children with steroid-sensitive nephrotic syndrome (SSNS) despite the tangible initial response. Several factors have been documented as triggers for frequent relapses (FR). However, the role of urinary tract infection (UTI) was not well-illustrated. Our aim was to evaluate the role of UTI as a trigger for FR among Iraqi children SSNS. This cross-sectional study was conducted on a total of 68 children with the first episode of SSNS who were followed up for 6 months after taking their treatment for the first episode. The patients were divided into two groups: frequent and infrequent relapse. Midstream urine samples were collected from each child and routine bacteriological culture and detection were achieved. Data regarding age at onset, sex, steroid therapy at the onset, the time between the onset and first relapse were collected from patients’ records. The proportion of frequent relapses was 41.18%. UTI affected 22 (32.35%) patients with E. coli was the most common isolated bacteria accounting for 63.64% followed by Klebsiella pneumonia (18.18%), Proteus spp. and Pseudomonas aeruginosa (13.64% for each). In univariate analysis, each of age at onset, inadequate therapy for the first episode, and UTI were significantly associated with frequent relapse. However, in multivariate analysis, only adequate treated for first episode (OR= 0.26, 95%CI= 0.08-0.86, p= 0.028) and UTI (OR= 4.8, 95%CI= 1.22-18.87, p= 0.025) were significantly associated. In conclusion, UTI is an important cause of FR in children with SSNS. Therefore, affected children should be routinely investigated for such infection.