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Nephrotic Syndrome SBP Immunodeficiency — ESENeph MCQ

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ModerateGlomerulonephritisNephrotic Syndrome SBP ImmunodeficiencyESENeph

A 40-year-old man with nephrotic syndrome from MCD develops Streptococcus pneumoniae peritonitis. He has ascites from severe hypoalbuminaemia (albumin 9 g/L). What is the mechanism and significance?

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Correct answer: A — Spontaneous bacterial peritonitis (SBP) occurs in nephrotic syndrome due to: urinary loss of IgG and complement factors (impaired opsonisation), ascites from low oncotic pressure providing culture medium, and reduced splenic function; Streptococcus pneumoniae and E.coli are common pathogens

Nephrotic syndrome causes secondary immunodeficiency through urinary loss of IgG (impaired humoral immunity), complement components (C3, Factor B – impaired opsonisation), and reduced T-cell function. The combination of immunodeficiency and ascites (low-protein transudative fluid from hypoalbuminaemia) creates a high-risk environment for SBP. Encapsulated organisms (S. pneumoniae, particularly) are most dangerous due to the opsonisation defect. Pneumococcal vaccination is recommended for all nephrotic patients. Prophylactic antibiotics may be considered in children with nephrotic syndrome.

Reference: KDIGO 2021 – GN (Infection in NS); NICE – Pneumococcal Vaccination