Feldhoff C, Kleine L, Bachmann H
Abteilung für Paediatrische Nephrologie, Universitätsklinikum Essen.
Klin Padiatr. 1988 Jan-Feb;200(1):40-4. doi: 10.1055/s-2008-1033683.
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.
我们分析了1975年至1985年间在我们诊所接受治疗的23名儿童中与特发性肾病综合征（NS）相关的腹膜炎和/或败血症发作情况。婴儿型NS患儿中有37.5%、对类固醇敏感的NS患儿中有16%、对类固醇耐药的NS患儿中有13.6%发生了腹膜炎。婴儿型NS患儿及1名患有革兰阴性继发性腹膜炎的女孩出现了败血症。3名败血症患儿死亡。4例患者发生了肠穿孔继发的腹膜炎。原发性腹膜炎最常见的细菌病原体是肺炎链球菌（7例）。7例培养结果为阴性。所有腹膜炎发作均与肾病综合征活动期同时出现：超过半数患者已经开始使用皮质类固醇治疗。8例患者因疑似阑尾炎接受了手术探查，但阑尾组织学检查均未证实。有2例腹水中培养出肺炎链球菌。预防性接种多价肺炎球菌疫苗以及在NS急性发病期间尽早开始皮质激素治疗是必要的。
