Pediatric Nephrology

, Volume 28, Issue 11, pp 2125–2130 | Cite as

Seroprotection for hepatitis B in children with nephrotic syndrome

  • Mukta Mantan
  • Nagaraj Pandharikar
  • Sangeeta Yadav
  • Anita Chakravarti
  • Gulshan Rai Sethi
Original Article



Children with nephrotic syndrome have been shown to have lower seroconversion to various vaccines due to immune dysregulation, prolonged immunosuppressive treatment and recurrent prolonged proteinuria.The primary aim of this study was to determine hepatitis B surface antibody (anti-HBs) titers in children with nephrotic syndrome who had been previously vaccinated against hepatitis B. The secondary aim was to study the association of anti-HBs titers with type of disease, schedule and dose of vaccination, and type of immunosuppressive therapy.


This cross-sectional study was conducted in the Department of Pediatrics in a tertiary care hospital between January 2011 and January 2012). All children (aged 1–18 years) with nephrotic syndrome who tested negative for hepatitis B surface antigen and who had previously been vaccinated against hepatitis B, with the last dose being at least 1 month prior to being included in the study. A form consisting of history and clinical details was filled in, and the schedule and dose of vaccination(s) received was noted. A blood sample was taken from all patients for biochemical assessment and determination of anti-HBs titer.


The patient cohort comprised 75 children (51 males; 24 females) of whom 42 (56 %) had steroid-resistant nephrotic syndrome (SRNS) and 33 (44 %) had steroid-sensitive nephrotic syndrome (SSNS). Most patients enrolled in the study (96 %) were in remission at the time of the biochemical and serological assessment. Twenty-one (28 %) patients had received only steroids, while 72 % also received other immunosuppressants. Forty-six (61.3 %) patients had received a double dose of vaccine. Of the 75 children enrolled, 36 (48 %) and 39 (52 %) had an anti-HBs titer of ≥10 mIU/mL (seroprotected) and <10 mIU/mL (unprotected), respectively. The mean titer among all patients was 143.58 mIU/mL. The seroprotection rates were 63.6 % in SSNS patients and 35.7 % in SRNS subjects (P = 0.016).


Based on our results, we conclude that children with SRNS are less likely to seroconvert with vaccination. A higher dose (double) of hepatitis B vaccine should be used for vaccinating such patients. Anti-HBs titers should be monitored in SRNS patients post-vaccination, and a booster should be given if titers fall to <10 mIU/mL.


Hepatitis B Seroconversion Nephrotic syndrome 


Conflict of interest


Funding or competing interests



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Copyright information

© IPNA 2013

Authors and Affiliations

  • Mukta Mantan
    • 1
  • Nagaraj Pandharikar
    • 1
  • Sangeeta Yadav
    • 1
  • Anita Chakravarti
    • 2
  • Gulshan Rai Sethi
    • 1
  1. 1.Department of Pediatrics, Maulana Azad Medical College and Associated HospitalsUniversity of DelhiDelhiIndia
  2. 2.Department of Microbiology, Maulana Azad Medical College and Associated HospitalsUniversity of DelhiDelhiIndia

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