[Peritonitis and infection in children with idiopathic nephrotic syndrome]

We analyzed episodes of peritonitis and/or sepsis associated with the idiopathic nephrotic syndrome (ns) in 23 children treated between 1975 and 1985 at our clinic. 37.5% of the children with infantile ns, 16% of those with steroidsensible ns, and 13.6% of those with steroidresistant ns developed peritonitis. Children with infantile ns and one girl with gram-negative secondary peritonitis presented with sepsis. 3 septic children died. Four patients developed peritonitis secondary to intestinal perforation. The most common bacterial pathogen in primary peritonitis was S. pneumoniae (7 patients). 7 cases were culture-negative. All episodes of peritonitis coincided with an active nephrotic syndrome: in more than half of the patients therapy with corticosteroids had already been started. Eight patients underwent surgical exploration for presumed appendicitis, but none was confirmed by histological examination of the appendix. In 2 instances S. pneumoniae was cultured from ascitic fluid. Prophylactic polyvalent pneumococcal vaccination and early start of corticotherapy during the acute illness of ns is warranted.