[FSUSTC]

Why patient in minimal change disease develop spontaneous bacterial peritonitis ?

 

[khanar]

Low immunity in nephrotics

All I know is that nephrotics have increased risk of infections with encapsulated microorganisms due to lowered immunity.
SBP is mainly caused by Streptococcus pneumoniae and therefore nephrotics are at increased risk of developing this.
Is there any reason? Please tell

 

[FSUSTC]

IN MCD .... there is loss of protein which include immunoglobulin ... as they are protein too ... so they have low immunity and most prone to infection ..
In MCD ... as protein losses causes pleural effusion ascitis due to decrease in onchotic pressure .... so when there is ascitis with decrease body immunity , increase chance of ascitis fluid infection .... which causes SBP , most commonly with streptococcus ....

 

[khanar]

IN MCD .... there is loss of protein which include immunoglobulin ... as they are protein too ... so they have low immunity and most prone to infection ..
In MCD ... as protein losses causes pleural effusion ascitis due to decrease in onchotic pressure .... so when there is ascitis with decrease body immunity , increase chance of ascitis fluid infection .... which causes SBP , most commonly with streptococcus ....

Aha .. that makes sense

 

[rasheed]

Have a look at this thread also
http://www.usmle-forums.com/usmle-step-2-ck-bits-pieces/1985-dealing-peritonitis-questions.html

 

[anoop_1198]

Opsonization

But why chances of infection with encapsulated organisms increase? same happens after splenectomy and the person requires vaccines against encapsulated organisms.. I tried finding out ..and found out that it has something to do with opsonization and the polysaccharide cell wall but didn't really get it. Someone with knowledge please explain.

 

[lee-usmle]

Why nephrotics get infections

There are a number of proposed (not yet proven) mechanisms that lead to the susceptibility of nephrotics to infections. These are:

• Decreased immunoglobulin levels.
• Edema fluid acting as a culture medium.
• Protein deficiency.
• Decreased bactericidal activity of the leukocytes.
• Immunosuppressive therapy.
• Decreased perfusion of the spleen caused by hypovolemia.
• Urinary loss of a complement factor (properdin factor B) that opsonizes certain bacteria.

The last two points explain the defective immunity against encapsulated microorganisms.

 

[khanar]

Great explanation

Thank you Lee-USMLE you summarized the whole thing

 

[aungawa]

Thanks for your thorough explanation !

Dr. Lee, thanks for your explanation !