From the Research
Peritonitis in nephrotic syndrome is a severe condition due to the compromised immune system, making it difficult to contain and eliminate bacterial infections, and is associated with higher morbidity and mortality rates compared to peritonitis in patients without nephrotic syndrome. The condition is characterized by significant protein loss through the kidneys, including immunoglobulins and complement factors that are essential for fighting infections, as noted in studies such as 1. This protein depletion leads to a compromised immune system, making it difficult for the body to contain and eliminate bacterial infections in the peritoneal cavity. Some key points to consider include:
- The use of immunosuppressive medications to treat the underlying nephrotic syndrome further weakens immune responses, as seen in patients with nephrotic syndrome 2.
- The peritoneal fluid in these patients often has high protein content, creating an ideal medium for bacterial growth, which can lead to severe infections such as those caused by Streptococcus pneumoniae 3.
- Edema in the intestinal wall can also compromise gut barrier function, potentially allowing bacterial translocation from the intestines into the peritoneal cavity, as suggested by the findings of 4.
- Nephrotic patients frequently have low serum albumin levels, which impairs the transport of antibiotics to infection sites, reducing treatment efficacy, as noted in 5. These combined factors make peritonitis in nephrotic syndrome not only more likely to occur but also more difficult to treat effectively. It is essential to establish a diagnosis early and initiate broad-spectrum antimicrobial therapy even before culture results are available, as recommended by 1, to improve patient outcomes. In terms of prevention, pneumococcal vaccination may be considered for patients with steroid-dependent or steroid-resistant nephrotic syndrome, as suggested by 5. However, the decision to vaccinate should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history. Overall, peritonitis in nephrotic syndrome requires prompt and aggressive treatment to reduce the risk of severe complications and improve patient outcomes.