Peritonitis in children with nephrotic syndrome

M. J. Gorensek, M. H. Lebel, J. D. Nelson

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

In a retrospective review of 214 children with nephrotic syndrome seen at Children's Medical Center and Parkland Memorial Hospital in Dallas throughout the 20-year period from 1967 to 1986, 62 cases of primary peritonitis were identified in 37 patients (17.3% rate). Streptococcus pneumoniae was the major pathogen, accounting for 38% of the cases. An additional 27% of patients had negative culture results but were clinically responsive to penicillin. Gram-negative organisms were cultured from only 3% of patients; 5% were caused by α-streptococci and 2% each by enterococcus and anaerobes. In 23% of cases the cause was unknown. Our findings differ from the recent trend in the literature in which Gram-negative organisms associated with these infections are increasingly implicated. The incidence and bacteriology of peritonitis do not appear to have changed significantly during the 20-year period. Clinically, peritonitis was characterized by abdominal pain (98%), fever (95%), rebound tenderness (85%), and nausea and vomiting (71%). A total of 79% of patients were either in relapse or receiving steroid therapy at the time peritonitis was diagnosed; 13% had infiltrates visible on their chest radiographs. Based on our data, it seems reasonable to initiate antimicrobial therapy in nephrotic children with suspected peritonitis using a combination of penicillin plus either an aminoglycoside or a cephalosporin. This regimen should continue until culture results are available, unless Gram-positive diplococci are identified in a Gram-stained specimen of peritoneal fluid, in which case penicillin alone should suffice.

Original languageEnglish (US)
Pages (from-to)849-856
Number of pages8
JournalPediatrics
Volume81
Issue number6
StatePublished - 1988

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Nephrotic Syndrome
Peritonitis
Penicillins
Bacteriology
Ascitic Fluid
Enterococcus
Aminoglycosides
Cephalosporins
Streptococcus pneumoniae
Streptococcus
Nausea
Abdominal Pain
Vomiting
Fever
Thorax
Steroids
Recurrence
Incidence
Therapeutics
Infection

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Gorensek, M. J., Lebel, M. H., & Nelson, J. D. (1988). Peritonitis in children with nephrotic syndrome. Pediatrics, 81(6), 849-856.

Peritonitis in children with nephrotic syndrome. / Gorensek, M. J.; Lebel, M. H.; Nelson, J. D.

In: Pediatrics, Vol. 81, No. 6, 1988, p. 849-856.

Research output: Contribution to journalArticle

Gorensek, MJ, Lebel, MH & Nelson, JD 1988, 'Peritonitis in children with nephrotic syndrome', Pediatrics, vol. 81, no. 6, pp. 849-856.
Gorensek MJ, Lebel MH, Nelson JD. Peritonitis in children with nephrotic syndrome. Pediatrics. 1988;81(6):849-856.
Gorensek, M. J. ; Lebel, M. H. ; Nelson, J. D. / Peritonitis in children with nephrotic syndrome. In: Pediatrics. 1988 ; Vol. 81, No. 6. pp. 849-856.
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