Secondary Immunodeficiency Related to Kidney Diseases in Children

Abstract

Author: Shiri Barshay. Research title: Secondary Immunodeficiency Related to Kidney Diseases in Children. Aim: To analyze current literature on secondary immunodeficiency related to kidney disease (SIDKD) with the focus on pediatric patients. Objectives: 1. To present the concept of SIDKD. 2. To review kidney diseases associated with secondary immunodeficiency (SID). 3. To investigate the pathophysiological mechanisms that contribute to SIDKD. 4. To investigate the clinical impact of SIDKD. Research methodology: This is a literature review based on “PubMed” database. The search strategy included the following keywords: “kidney disease”, “chronic kidney disease”, “secondary immunodeficiency”, “secondary immunodeficiency related to kidney disease”, “nephrotic syndrome”, “uremic toxins”, “infection risk in kidney disease”, “impaired vaccine response” and “treatment related immunodeficiency”. English language full text articles relevant to this review objectives were included, focusing mainly on pediatric patients. Results: The reviewed literature showed that although there is increased recognition of SIDKD, a clear definition is still missing. In children, it is mainly associated with minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS) and immunoglobulin A (IgA) nephropathy. The main mechanisms are urinary loss of immunoglobulins and complement proteins in nephrotic syndrome and the accumulation of uremic toxins in chronic kidney disease (CKD). These cause higher infection risk, impaired vaccine response and additional immunosuppressive treatment. Conclusions: SIDKD is acquired immune dysfunction caused by kidney disease. In children, it is especially relevant in MCD, FSGS and IgA nephropathy. The main consequences are increased infection risk, reduced vaccine response and worsening of immunodeficiency due to required immunosuppressive therapy. Recommendations: Greater clinical awareness of SIDKD is needed in pediatric nephrology. Early recognition of infections, attention to vaccination importance and careful monitoring during immunosuppressive therapy can help reduce complications and improve patient care.