Effect of Jawarish Zarooni and Sharbat Buzoori in a Diagnosed Case of Nephrotic Syndrome
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Abstract:
Nephrotic syndrome is a manifestation of kidney disease involving the glomeruli, characterized by oedema, proteinuria, hyperlipidemia and low serum albumin. It may be caused by primary kidney disease such as focal segmental glomerulosclerosis, and mutations in the podocin gene (shown in familial and sporadic forms of steroid-resistant nephrotic syndrome). A study by Michael B. Rothenberg and Walter Heymann M. showed 5-year survey of the incidence of the nephrotic syndrome in children in the state of Ohio, in which there were 0.5 new cases per year per 100,000 total populations and 2.3 new cases per year per 100,000 children aged 0 to 9 years with a total population of 8,000,000. Recent prospective studies revealed an incidence of 1.15 to 2.1/100,000 children/year. We presented a case of nephrotic syndrome treated with Unani formulation “Jawarish Zarooni” along with Sharbat Buzoori. Patient responded well and got complete relief with the formulation. Keywords : Glomerulosclerosis, Jawarish Zarooni, nephrotic syndrome, podocin gene, Sharbat Buzoori Cite this Article Rabia Nizam, Mohammad Shakeel Ansari, Fazlur Rehman. Effect of Jawarish Zarooni and Sharbat Buzoori in a Diagnosed Case of Nephrotic Syndrome. Research & Reviews: Journal of Surgery . 2020; 9(1): 33–35p.Keywords:
Podocin
Hyperlipidemia
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A clinicopathological study of 206 Indian children with nephrotic syndrome showed a primary renal cause in 195 (96%), of which 77% were boys. In 126 children (96 boys, 30 girls) onset of the disorder occurred before the age of 5 years. Renal biopsy showed minimal lesions in 150 patients (77%); in 85 of these biopsy was done 3 months to 16 years after onset of the nephrotic syndrome. Significant renal histological abnormalities in 45 cases were labelled as mesangiocapillary 8, mesangioproliferative 4, proliferative with extensive crescents 2, membranous 3, focal segmental glomerulosclerosis 9, focal global glomerulosclerosis 2, advanced nonspecific 8, and mild proliferative 9. Nephritic manifestations were mainly associated with significant renal lesions, which were more frequently encountered when the onset of disease was after the age of 5 years. Clearance of proteinuria with corticosteroid therapy was practically confined to patients with minimal or mild renal histological changes. Our findings suggest that the pattern of idiopathic nephrotic syndrome in Indian children is similar to that reported from Western countries.
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Minimal change disease
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Membranous Nephropathy
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In this study, we reviewed the records and the histological findings of a total of 350 adequate native kidney biopsies at both the Jordan University Hospital (260 biopsies in the period 1986-1989) and the Jordan Hospital (90 biopsies in the period 1997-1999). There were 187 males (53.4%) and 163 females (46.6%). Their ages ranged between 12-77 years. The nephrotic syndrome was the presenting feature in 194 (55.4%) patients, acute renal failure in 55 (15.7%), hematuria and/or non-nephrotic proteinuria in 45 (12.9%), chronic renal failure in 32 (9.1%) and hematuria alone 24 (6.9%). In the patients with the nephrotic syndrome, 140 (72.2%) had primary nephrotic syndrome. In this group membranoproliferative glomerulonephritis (MPGN) was the most common pathology and was detected in 49 patients (35%) followed by focal segmental glomerulosclerosis (FSGS) in 38 (27.1%). Amyloidosis and systemic lupus erythematosus were the commonest findings among the 54 patients with secondary nephrotic syndrome (40.7% and 38.8% respectively). Rapidly progressive glomerulonephritis was seen in 34.5% of those patients presenting with acute renal failure, while FSGS was seen in 25% of those with chronic renal failure. Finally IgA nephropathy was the major finding among both the 45 patients with hematuria-proteinuria and the 24 patients with isolated hematuria (26.2% and 66.6% respectively).
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A prospective observational study of 43 children with idiopathic nephrotic syndrome (INS) were selected randomly out of 480 children admitted with the disease at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2003 to January 2005. Aim of this study was to correlate the difference in frequency of atopic attack, hypertension, complement c3 level and urinalysis in different types of Idiopathic nephrotic syndrome. Result: Among 43 children with idiopathic nephrotic syndrome (INS), 24 children were steroid sensitive nephrotic syndrome (SSNS) and 19 children having steroid resistant nephrotic syndrome (SRNS) cases, of SSNS group 13 were infrequent relapse nephrotic syndrome (IFRNS) and 11 were frequent relapse steroid dependant nephrotic syndrome (FRNS + SDNS). Bronchial asthma and allergic dermatitis were found in about 63% cases of both steroid resistant nephrotic syndrome (SRNS) and frequent relapse steroid dependant (FRNS+SDNS) group. Hypertension was found in higher number of patient in SRNS compared to SSNS (P> 0.05) It was absent in IFRNS. Steroid contributed more than the disease process in producing hypertension (P< 0.01). Complement C3 comparison among the group could not reach statistically significant level. Similarly, comparison of hematuria showed no difference among the groups but pyuria was higher in SRNS compared to IFRNS (P >0.05). UTI were found equally in all the groups. Conclusion: Higher incidence of asthma, atopic dermatitis were noted in all the groups of idiopathic nephrotic syndrome (INS). C3 was not found significantly low in INS. Persistent elevation of blood pressure is found in higher number of SRNS compared to SSNS and steroid contributed more than the disease process. DOI: http://dx.doi.org/10.3329/bjch.v35i1.10367 BJCH 2011; 35(1): 11-15
Prednisolone
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Objective: To study longterm renal outcome of Thai children with idiopathic nephrotic syndrome (INS). Methods: We retrospectively reviewed 75 INS children followed-up in a tertiary care, university hospital. Male to female ratio was 2:1. Mean age at diagnosis was 6.2 years, and 56.0% were less than 5 years old. 57.3% previously received prednisolone from other hospitals and 32 patients (42.7%) were steroid resistant nephrotic syndrome (SRNS). Initial short stature was found in 1.3%. Hypertension and hematuria was found in 34.7% and 14.7%, respectively. Renal biopsy performed in 40 patients (53.3%) revealed minimal changes disease in 17 (42.5%), focal and segmental glomerulosclerosis (FSGS) in 12 (30.0%), mesangial proliferative glomerulonephritis in 5 (12.5%), IgM nephropathy in 4 (10%), and IgA nephropathy in 2 (5%) patients. Immunosuppressive medications included Cyclophosphamide in 64.5%, Tacrolimus in 14.7%, Cyclosporin in 8.0% and Mycophenolate mofetil in 4.0%. Enalapril was given in 48.0%. Results: Mean follow-up time was 7.4 years. Complete remission was achieved in 77.3%. One patients (1.3%) had Chronic Kidney Disease stage 3 and 5 patients (6.7%) had End Stage Renal Disease (ESRD). One patient with ESRD died of severe respiratory tract infection. The factor associated with poor renal outcome was FSGS (p=0.032). Renal survival at 5,10, and 15 years were 95.3%, 85.7% and 57.2%, respectively. At last follow-up, short stature was found in 4.0% and hypertension in 20.0%. Other complications included cataract (29.3%), glaucoma (9.3%), diabetes mellitus (2.6%), septicemia (9.3%), other infections (10.6%). Conclusion: We suggest that although renal outcome in Thai children may be better than in caucasian, longterm follow up is still needed, especially in children with FSGS.
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Membranous Nephropathy
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Minimal change disease
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Congenital and infantile nephrotic syndrome reported from the Eastern world is rare and might be a different entity from that in the West. In a retrospective review of 10 nephrotic syndrome in Thai infants (5 girls and 5 boys), 7 were diagnosed with congenital nephrotic syndrome and 3 with infantile nephrotic syndrome. Two had congenital nephrotic syndrome secondary to congenital syphilis. All had edema, ascites, and failure to thrive. Of the 3 patients tested for thyroid function, all showed hypothyroidism. Two patients developed renal failure. Renal tissue was examined from 4 patients from 3 biopsies and 2 autopsies; only 1 patient showed tubular microcysts. Symptomatic therapy was performed concurrently with penicillin therapy in 2 patients having congenital syphilis. Prednisolone, cyclophosphamide, captopril, and enalapril were tried in some patients, with little effect. Five patients died from respiratory failure complicated by later infection, 1 patient died from renal failure, and 4 patients were lost to follow-up. Nephrotic syndrome in the first year of life in the Eastern world is rare. Prognosis of nephrotic syndrome in Thai infants at this time is still poor.
Congenital nephrotic syndrome
Failure to Thrive
Congenital syphilis
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