Primary peritonitis in children with nephrotic syndrome: results of a 5-year multicenter study

  • Nermin Uncu
  • Mehmet Bülbül
  • Nurdan Yıldız
  • Aytul Noyan
  • Cemlettin Koşan
  • Salih Kavukçu
  • Salim Çalışkan
  • Zübeyde Gündüz
  • Nesrin Beşbaş
  • Ayfer Gür Güven
Original Paper


Primary peritonitis is a well-described infectious complication of nephrotic syndrome. Current data on the true incidence of peritonitis and efficacy of preventive pneumococcal vaccination are not clear in this group of children. In this nationwide study, among a total of 268 patients with an initial diagnosis of steroid sensitive nephrotic syndrome, eight episodes of primary peritonitis were detected in seven patients during 5 years. All eight attacks of peritonitis occurred in the relapse period. Seven of these peritonitis episodes occurred in the first 2 years of nephrotic syndrome, three of them during the first attack. One patient had two attacks with a 6-month interval. Only two of the patients were steroid sensitive, while four of them were steroid dependent, and one was steroid resistant at the diagnosis of peritonitis. The causing microorganism was identified in three patients (Streptococcus hemolyticus, Streptococcus pneumoniae, and α-hemolytic Streptococcus). Incidence of peritonitis (2.6%) in our series was not high when compared with previous reports. None of the patients had been immunized against pneumococcus before or after the peritonitis attack. It raises the question if the vaccine is necessary for every child with steroid sensitive nephrotic syndrome. However, we suggest that immunization against pneumococcus is not indicated in children with steroid-responsive nephrotic syndrome (NS) and should be reserved for the small number of children who have steroid-dependent or steroid-resistant NS.


Nephrotic syndrome Peritonitis Childhood Immunization 


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Nermin Uncu
    • 1
  • Mehmet Bülbül
    • 2
  • Nurdan Yıldız
    • 3
  • Aytul Noyan
    • 4
  • Cemlettin Koşan
    • 5
  • Salih Kavukçu
    • 6
  • Salim Çalışkan
    • 7
  • Zübeyde Gündüz
    • 8
  • Nesrin Beşbaş
    • 9
  • Ayfer Gür Güven
    • 10
  1. 1.Pediatric NephrologyMinistry of Health Diskapi Children’s HospitalAnkaraTurkey
  2. 2.Pediatric NephrologyMinistry of Health Dr Sami Ulus Children’s HospitalAnkaraTurkey
  3. 3.Pediatric NephrologyMinistry of Health Goztepe Research HospitalIstanbulTurkey
  4. 4.Pediatric NephrologyCukurova University, School of MedicineAdanaTurkey
  5. 5.PediatricsAtaturk University, School of MedicineErzurumTurkey
  6. 6.Pediatric NephrologyDokuz Eylul University, School of MedicineIzmirTurkey
  7. 7.Pediatric NephrologyIstanbul University, Cerrahpasa School of MedicineIstanbulTurkey
  8. 8.Pediatric NephrologyErciyes University School of MedicineKayseriTurkey
  9. 9.Pediatric NephrologyHacettepe University, School of MedicineAnkaraTurkey
  10. 10.Pediatric NephrologyAkdeniz University, School of MedicineAntalyaTurkey

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