Effectiveness and Safety of Rehabilitation for Pediatric Patients with Nephrotic Syndrome in the Acute Phase: A Case Study
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Background: Exercise therapy for patients with pediatric nephrotic syndrome is necessary to improve physical function to maintain the patient’s activities of daily life and school life while managing the risk of relapse; however, few studies have examined exercise therapy in the acute phase of the syndrome. This case study aimed to evaluate the efficacy and safety of exercise therapy in a patient with acute pediatric nephrotic syndrome being treated with steroids.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.
Podocin
Hyperlipidemia
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Nephrotic syndrome is common in patients with chronic kidney diseases. With the improvement of the socioeconomic status, lifestyle, and living environment, the epidemiological characteristics of nephrotic syndrome have changed significantly. The incidence of nephrotic syndrome is increasing in the elderly, pregnant women, and patients with diabetes and cancer. The major complications of acute kidney injury, thromboembolic events, and infections, have shown novel features in the nephrotic patients. Therefore, it is of great significance to understand the epidemiological characteristics of nephrotic syndrome for the clinical precise diagnosis and treatment of nephrotic syndrome, as well as improvement of its clinical control.
Key words:
Nephrotic syndrome; Epidemiology
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Background: End-stage kidney disease has several causes, including nephrotic syndrome (NS). Steroid- resistant nephrotic syndrome (SRNS) children are a difficult subset of nephrotic syndrome patients who frequently respond poorly to conventional immunosuppression. Objective: The goals of our research are to analyze the different types of nephrotic syndrome, to study the epidemiological, clinical and paraclinical profile, as well as to present the difficulty in managing steroid-resistant nephrotic syndrome. Methods: Our study is a cross-sectional analysis of all patients hospitalized or followed in consultation, who were diagnosed with a nephrotic syndrome at the pediatric B department of the university hospital center Mohamed VI in Marrakech, from January 2011 to January 2022. Results: We gathered 447 instances, with an annual incidence of 41 cases. The children's ages varied from 12 days to 16 years, with an average of 5 years and 9 months. Pure nephrotic syndrome was found in 302 patients and 145 patients were carriers of impure nephrotic syndrome. In our study, 81.5% of patients had nephrosis as the cause of deseas. Secondary NS was seen in 11% of the patients, infant form was found in 6% and 1.5% of cases were congenital. The treatment was mainly based on oral corticosteroid therapy. 71.4% of the patients were corticosensitive of which 45.3% became corticodependent while 28.6% of the cases were corticoresistant. Corticosteroid boluses were used in 53% of cases. Immunosuppressants were prescribed in 31.5% of patients. Conclusion: In children, nephrotic syndrome is a common and chronic illness. It is of particular interest because of the frequency of nephroses, multiple relapses, the difficulties of management and the psychological and school impact on the child.
Nephrosis
Immunosuppression
Minimal change disease
Congenital nephrotic syndrome
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Background: Nephrotic syndrome common disease in children. To study the lipid profile in nephrotic syndrome.
Methods: This is a case-control study in which 100 Normal patients and 100 patients. The Serum lipid profiles of the patients were evaluated.
Results: There was a significant increase in Total cholesterol, HDL, LDL, VLDC & TG in Nephrotic patients when compared to Controls. The study finding conclude that the serum lipid profile shoed noticeable increase in the nephrotic syndrome in Indian patients.
Conclusion: We concluded that nephrotic patients are having hyperlipidaemia. This hyperlipidaemia may progress in to the cardiovascular diseases. Hence the lipid profile in the nephrotic syndrome must be monitored for better management of the diseases.
Keywords: Lipid profile, Nephrotic syndrome, Hyperlipidemia
Hyperlipidemia
Lipid Profile
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The nephrotic syndrome is a constellation of renal and extrarenal manifestations that can be caused by a multitude of systemic diseases as well as by primary insults to the kidney. The prevalence of the syndrome depends largely on the underlying causes, which vary significantly by age of onset. The nephrotic syndrome is classically characterized by 6 main abnormalities of which proteinuria of greater than 3.5 g/24 hr is the cornerstone. The cardinal manifestations of the nephrotic syndrome include edema, hypoalbuminemia, hyperlipidemia, and lipiduria. Hypercoagulability is also a well-known complication of the nephrotic syndrome. Because of the diversity of disease processes that can cause the nephrotic syndrome, the prognosis and treatment vary dramatically depending on the underlying etiology. This article reviews the presentation, complications, and common underlying causes of the nephrotic syndrome and briefly discusses the diagnostic work-up and treatment.
Hypoalbuminemia
Etiology
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Pediatric nephrotic syndrome is defined by the presence of nephrotic range proteinuria, hyperlipidemia, and hypoalbuminemia. It is the commonest glomerular disease and 15 times more common in children than adults. The incidence is popular in Asian population than Europeans with 9-16 per 1,00,000. Here we reported 3 cases of steroid dependence nephrotic syndrome under 10 years of age. All the three cases having the classical features of nephrotic syndrome like facial puffiness, pedal edema and proteinuria. Corticosteroid is the drug of choice for nephrotic syndrome. So it is necessary to counsel the patient caregivers about need of proper follow up, weight checkup, growth measurement etc.
Hypoalbuminemia
Hyperlipidemia
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Nephrotic syndrome is one of the prevalent diseases in pediatric population. Its prevalence is about 2-7 in per 100000 children. Nephrotic syndrome has evolved as an immunological condition having characteristics of massive proteinuria, (>40 mg/m2/hrs.), hypoalbuminemia (albumin <2.5g/dL), hyperlipidemia (cholesterol > 200mg/dl) and edema which start from face. 90% of children will have idiopathic nephrotic syndrome, whereas the remaining 85% will have minimal change nephrotic syndrome. However, a histological categorization of Nephrotic Syndrome may be done as Primary Nephrotic Syndrome, in which - Nephrotic syndrome can be caused by numerous sources and can be either entirely due to disease/damage of the Glomerulus and restricted to the kidney. One of the basic Nephrotic syndromes is minimal change Nephrotic disease, which is relatively prevalent in youngsters, and there will be normal appearance of Nephron and kidney under optical microscope. This is the most typical reason for Primary Nephrotic Syndrome which is also known as Idiopathic Nephrotic Syndrome. Prognosis of this syndrome is depended on responsiveness of the patient toward steroids. Most of patients are sensitive to steroids initially and later become steroid dependent or resistant. It has been noted that, after giving treatment with protocol to steroid dependent and resistant patients with variable result outcome and with more side effects. Hence there is need of certain type of medicine and formulation which shows no side effects and having more potency to treat the Nephrotic Syndrome. Although Ayurveda does not identify any disease as Nephrotic syndrome, the similarities between signs and symptoms and a group of diseases with Ojas and its aberrations addressed in various Ayurveda classics. However, Ayurvedic therapy is heavily reliant on Dhatwagnimandhya treatment by Amapachana, Ojovardhaka, Rasayana treatment, and Medhovaha Srotodusti treatment. Mutrala and renal protective drugs should also be examined. Author make an effort to elaborate etiopathogenesis, pathology, sign and symptoms in the light of Ayurveda along with role of herbs in the management of nephrotic syndrome. Key words: Nephrotic Syndrome, Ojas, Dhatwagnimandhya, Amapachana, Ojovardhaka, Mutrala
Hypoalbuminemia
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Nephrotic syndrome is a relatively rare but serious condition in children. Infantile nephrotic syndrome often has a genetic origin; the treatment is then symptomatic, with a poor prognosis, and a rapid evolution to chronic kidney disease. However, non-genetic infantile nephrotic syndrome has been identified. Here we report for the first time in a child a nephrotic syndrome as the sole clinical expression of a cytomegalovirus infection. The patient was 5 months old when he presented with a nephrotic syndrome. An exhaustive genetic testing was conducted and came back negative. A viral work-up only showed a positive cytomegalovirus PCR. Antiviral treatment lead to a complete remission of the nephrotic syndrome, with no requirement for steroid therapy. Renal function remained normal throughout follow-up. Nephrotic syndrome should always be carefully investigated in children. This observation reinforces the connection between viral infections and pediatric nephrotic syndrome, sparking more controversy about an infectious origin to childhood nephrotic disease.
Cytomegalovirus
Nephrology
Congenital nephrotic syndrome
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