DR SYSNDROM nephrotic Harshad RAVAL MD HOMEOPATHY TREATMENT
Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein [1] (proteinuria at least 3.5 grams per day per 1.73m2 body surface area) [2] of the blood in urine.
Definition: Nephrotic syndrome is a group of symptoms including protein in the urine (more than 3.5 grams per day) low blood protein, high cholesterol levels, and swelling. The urine may also contain fat, which can be seen under the microscope.
Kidneys affected by nephrotic syndrome have small pores in the podocytes, large enough to allow proteinuria (and thereafter, hypoalbuminemia, because some of the protein albumin in the blood has passed into the urine) but not large enough to allow the cells through (so no hematuria). By contrast, nephritic syndrome, red blood cells pass through the pores, causing hematuria.
Causes and risk factors:
Nephrotic syndrome is caused by various disorders that damage the kidneys, particularly the basement membrane of the glomerulus. This immediately causes excretion abnormal protein in the urine.
The most common cause in children is minimal change disease, while membranous glomerulonephritis is the cause more common in adults.
This condition can also occur as a result of infection, the use of certain drugs, Caner, genetic disorders, immu disorders or diseases that affect multiple body systems including diabetes, multiple myeloma and amyloidosis.
It can accompany disorders kidney such as glomerulonephritis, focal segmental glomerulosclerosis and glomerulonephritis mesangiocapillary.
Nephrotic syndrome can affect all groups of age. In children, it is most common between the ages of 2-6. This disorder occurs slightly more often in men than in women.
Presentation:
It is characterized by proteinuria (> 3.5g/day), hypoalbuminemia, hyperlipidemia and edema. Some other features are:
common sign is the excess fluid in the body. This can take several forms:
Swelling around the eyes, characteristically in the morning.
Edema in the legs which is pitting (ie leaves a little hole when the liquid is pressed out, which resolves in a few seconds.)
Fluid in the pleural cavity causing pleural effusion. More commonly associated with excess fluid is pulmonary edema.
The fluid in the peritoneal cavity causing ascites.
Hypertension (rare)
Some patients may notice foamy urine, due to a decrease in surface tension by severe proteinuria. Real problems urinals as hematuria or oliguria are rare, and are commonly in nephritic syndrome.
You can have characteristics of the underlying cause, such as the eruption associated with systemic lupus erythematosus or neuropathy associated with diabetes.
The review should also exclude other causes of gross edema, especially the system cardiovascular and liver.
Investigations:
The following are relevant, essential research
Urine sample shows proteinuria (> 3.5 per 1.73 m2 per 24 hours). Also examined for urinary casts, which is more a feature of active nephritis.
Comprehensive metabolic panel (CMP) shows Hypoalbuminemia: albumin level? 2.5g/dL (normal = 3.5-5g/dL).
High levels of cholesterol (hypercholesterolemia) specifically elevated LDL, usually concomitantly with the elevation of VLDL
Electrolytes, urea and creatinine (such certificates) to evaluate the function renal
Other investigations are indicated if the cause is unclear
Kidney biopsy:
autoimmune markers (ANA, ASOT, C3, cryoglobulins, serum electrophoresis)
Classification and causes:
Nephrotic syndrome has many causes and can be the result of a disease limited to the kidney, known as primary nephrotic syndrome, or condition that affects the kidneys and other body parts, known nephrotic syndrome secondary.
The main causes:
The main causes of nephrotic syndrome are described usually with the histology, ie, minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS) and membranous nephropathy (MN).
Are considered "diagnoses of exclusion", ie, the diagnosis is made only after secondary causes have been excluded.
Secondary causes:
Secondary causes of nephrotic syndrome have the same histological patterns that the main causes, although may have some differences that suggest a secondary cause, such as inclusion bodies.
They are usually described by the underlying cause.
The secondary causes:
Hepatitis B
Sjögren's syndrome
Erythematosus (SLE)
Diabetes mellitus
Sarcoidosis
Syphilis
Drugs
Malignancy (cancer)
Focal segmental glomerulosclerosis (FSGS) [3]
Hypertensive Nefroesclerosis
Human Immunodeficiency Virus (HIV)
Diabetes mellitus
Obesity
Kidney loss
Minimal change disease (MCD) [3]
Drugs
Malignancy, especially Hodgkin lymphoma
The differential diagnosis of gross edema:
When someone presented with generalized edema, the causes must exclude the following:
Heart failure: The patient is older, with a history of heart disease. pressure jugular vein rises on the review, you can hear heart murmurs. An echocardiogram is the gold standard examination.
Hepatic impairment: The history suggestive hepatitis / cirrhosis, alcoholism, IV drug use, some hereditary causes.
Stigmata of liver disease are seen: jaundice (yellow skin and eyes), enlarged veins at the umbilicus (caput medusae), stripes (caused by generalized pruritus, known as "pruritus"), splenomegaly, spider veins, encephalopathy, hematoma, nodular liver
Acute fluid overload in people with kidney failure: These people are known to have kidney failure, and have either too much to drink or were on dialysis.
Metastatic cancer: Cancer of seeds of the lungs or abdomen caused by fluid spills and due to obstruction of lymphatics and veins serous exudation, as well. DIAGNOSIS
The diagnosis is based on blood and urine and sometimes images of the kidneys, kidney biopsy, or both.
Treatment includes:
General measures (support)
Monitor and maintain the euvolemic (the correct amount of fluid in the body):
control of urine output, BP regularly
limited to liquid 1L
diuretics (Furosemide IV)
Control of renal function:
make these certificates on a daily basis and calculation of GFR
Prevent and treat any complications [More below]
Infusions of albumin are not used because its effect lasts only temporarily.
Prophylactic anticoagulation may be appropriate in some circumstances. [4]
Specific treatment of underlying cause
Immunosuppression for glomerulonephritides (corticosteroids [5] cyclosporine).
Standard ISKDC scheme first episode: -60 prednisolone mg/m2/day in 3 divided doses for 4 weeks followed by 40 mg/m2/day in a single dose alternate days for 4 weeks.
Relapses of prednisolone 2 mg / kg / day until urine becomes negative for protein. Then, 1.5 mg / kg / daily for 4 weeks.
frequent relapses treated by cyclophosphamide or nitrogen mustard or cyclosporine or levamisole.
Achieving tighter control blood glucose in diabetics.
Control of blood pressure. ACE inhibitors are the drug of choice. Regardless of the antihypertensive effect has been demonstrated to minimize loss of protein. Dietary recommendations
This section does not cite any references or sources. Please help improve this article by adding citations from reliable sources. unverifiable material may be challenged and removed. (August 2008)
Reduce sodium intake to 1000-2000 mg a day. Foods high in sodium include salt used in cooking and at the table, the seasoning mix (salt, garlic, adobo, salt, season, etc.), canned soups, canned vegetables containing salt, meat cold as turkey, ham, mortadella, salami and prepared foods, fast foods, soy sauce, ketchup and salad dressings. On food labels, milligrams of sodium compare the calories per serving. Sodium should be less than or equal to the calories per serving.
Eating a moderate amount of protein foods animal high: 3-5 ounces per meal (preferably lean cuts of meat, fish and poultry)
Avoid saturated fats like butter, cheese, fried foods, fatty cuts of red meat, egg yolk, and the skin of poultry. Increase intake of unsaturated fats, like olive oil, canola oil, peanut butter, avocados, fish and nuts. Eat low-fat desserts.
Increase consumption of fruits and vegetables. There is no restriction of potassium or phosphorus is needed.
Monitor fluid intake, which includes all liquids and foods that are liquid at room temperature. fluid management in the syndrome Nephrotic is tenuous, especially during a flare.
Complications:
Venous thrombosis: due to seepage of antithrombin 3, which helps prevent thrombosis. This often occurs in the renal veins. Treatment is with oral anticoagulants (heparin heparin acts not through antithrombin 3, proteinuria is lost and it will be ineffective.)
Infections due to loss of immunoglobulins, encapsulated bacteria such as Haemophilus influenzae and Streptococcus pneumonia can cause infection.
Acute renal failure is due to hypovolemia. Despite the excess fluid in the tissues, there is less fluid in the vasculature. The decreased blood flow to the kidneys causing them to shutdown. Therefore, it is a tricky task to get rid of excess fluid in the body, keeping euvolemia circulation.
Pulmonary edema: again due to leakage of fluid, sometimes seeps into the lungs causing hypoxia and dyspnea.
Stunting: does not occur in MCNS.It occurs in cases of relapse or resistance to treatment. The causes of stunting are protein deficiency protein loss in the urine, anorexia (reduced intake of protein) and steroid therapy (catabolism).
Vitamin D deficiency can occur. Thyroxine is reduced due to decreased thyroid binding globulin.
Microc
http://www.homeopathyonline.in/kidneydisease.htmytic hypochromic anemia is typical. Resistant to iron therapy.
http://www.homeopathyonline.in/kidneydisease.htm
Blog: www.drharshadraval.com/
About the Author
Dr Harshad Raval MD[hom]
Honorary consultant homeopathy physician to his Excellency governors of Gujarat India. Qualified MD consultant homeopath ,International Homeopathy adviser, books writer and columnist. Specialist in kidney, cancer, psoriasis, leucoderma and other chronic disease,. www.homeopathyonline.in email : info@homeopathyonline.in
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