Question of the Week

Question :

Posted On : 10 Mar 2008

A 3 year old male child presented with complaints of generalized swelling of the body and scanty urine for 1 week. No past history of sore throat or pyoderma. On examination, anasarca, bp 98,52. Other systems normal. Urinalysis: protien plus plus plus , puscells 10-15, Rbc occassional,h.p.f.,coarse granular casts plus plus , Hb. 9.2gm,TLC : 10800,P 64,L33,E -3 Percent. ESR:77mm,1st. hr. Bun 22,s. creatinine 0.7, s. cholestrol :438, Total proteins : 5g, Albumin 2.6g. Urine culture: Klebsiella {Sig.} S : Amikacin,Nitrofurantoin,gentamycin. Ultrasound scan of KUB : NAD Mantoux test negative, Xray chest normal. This child was diagnosed as Nephrotic syndrome and UTI. He was give Inj Amkacin x 10 days and put on Prednisolone 2mg,kg,d. His urinary flow increased and proteinuria subsided to plus but pus cells were still 6-8,hpf.and urine culture continued to be positive on 3 weekly repetitions. Repeat ESR 42mm and se cholestrol ,370 after 4 weeks of steroids. After mikacin he was put on furadantin 6mg,kg,day for 2 weeks and then on 2mg,kg,day,on which he is still continued to combat a chronic UTI. The query is: 1.Is the UTI persisting because of steroid therapy? 2.Should steroids be discontinued and restarted after urine culture is sterile on at least 2 repetitions?

Expert Answer :

No expert answer available.

Answer Discussion :

sawsan issa

yes uti still because of steriod therapy

17 years ago

saada abikamel

yes steroid might be,he responded to it so we can stop it to treat the UTI

17 years ago

pediatriconcall

One must quantify the growth of the organism in the urine culture. It should be more than 100000 colonies for it to be significant. If the growth is significant, then treat the infection first and then start treatment for nephrotic syndrome once the infection is under control. In a child who is already on steroids, treat the infection and taper of the steroids. Once infection is cured, reintroduce the steroids and treat with full ISKDC regime right from beginning.

17 years ago

rahul chanchlani

1... no
2... no steroids should not be discontinued

17 years ago

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