Hepatitis B Seroprotection in Pediatric Nephrotic Syndrome

Objectives: To study the prevalence of Hepatitis B seroprotection in children (>1 y) withnephrotic syndrome vaccinated against Hepatitis B vaccine as per the UniversalImmunization Program schedule (0,6,10,14 wk); to compare the Hepatitis B seroprotectionrates and anti-HBs titers among different phenotypes of nephrotic syndrome; to evaluate theassociation between Hepatitis B seroprotection status and the immunosuppressive agents;and to study the correlation between anti-HBs titres and proteinuria. Methods: Hepatitis Bserology and anti-HBs titers were analyzed in 100 children (age-1-18 y) with different clinicalphenotypes of nephrotic syndrome (cases) and 100 healthy controls. Results: Theproportion of seroprotected children among the cases and controls was 37% (n=37) and 61%(n=61), respectively (P<0.04). The median (IQR) anti- HBs antibodies titers among the caseswas 75 (62.5, 81) mIU/mL and 112 (56, 367) mIU/mL among the controls (P=0.001). Theproportion of seroprotected children among the steroid sensitive nephrotic syndrome, steroid-resistant nephrotic syndrome and controls was 40% (n=28), 30% (n=9) and 61% (n=61),respectively (P<0.01). No differences in the anti-HBs titers between children receivingsteroids versus steroids along with other immunosuppressants were found. Weak negativecorrelation was noted between proteinuria and protective titers (r = -0.155; P=0.039).Conclusion: Children with nephrotic syndrome, in general, and steroid-resistant nephroticsyndrome in particular, show poor seroprotection with Hepatitis B vaccination.

Chronic Hypoxemia in a Child: Thinking Outside the Box.

Background: Chronic hypoxemia is generally attributed to primary cardiac or pulmonary entities. Case characteristics: A 9-year-old boy presenting with cyanosis, clubbing and hypoxemia, without icterus or hepatosplenomegaly. Cardiovascular and respiratory system examinations were normal. Outcome: He was diagnosed as type IB Abernethy malformation, a rare cause of hepatopulmonary syndrome. Message: Pediatricians should consider hepatopulmonary syndrome in the differential diagnosis of chronic hypoxemia, even in the absence of jaundice or hepatosplenomegaly.