DOC I HAVE NEPHROTIC SYNDROME
Nephrotic Syndrome is a rare disease characterized by the edema(accumulation of fluid in the body) and hypo-albumemia (low blood protein due to protein loss through the kidneys).
The cause is the increased capillary permeability of the glomeruli to plasma protein due to the inflammation and allows loss of blood and protein in the urine and retention of salt, water and nitrogen.
Loss of negative charges on the filtering membrane allows negatively charged molecules including albumin to enter the urinary tract.
Reduced protein in the blood leads to edema.
There are 3 types of Nephrotic Syndrome:
1.Minimal Change Nephropathy (MCN) occurs in children with very little microscopic changes in the glomerular tissues of the kidney.
2.Focal glomerulonephritis has appearance of MCN above but develop sclerosis of the glomeruli later.
3.Diffuse proliferative glomerulonephritis and membranous nephropathy are more common in adults and be secondary to other diseases such as:
a.SLE and other connective tissues
b.diabetes
c.allergies to drugs such as penicillinamine, tolbutamide, probenecid
d.certain infections
e.cancer (carcinomas and lymhomas)
Symptoms:
1.Urine may show the presence of protein at least 3.5g/day
2.low protein in blood causes decreased plasma mass pressure resulting in retention of water and salts
3.swelling of the face and ankle occurs as a result
4.edema ranges from puffiness of eyes, ascites (water in abdominal cavity), pleural effusions(water in the lungs) to generalized edema
5.With increasing edema and nitrogen retention, headaches, nausea and vomiting may occur.
6.high blood pressure may occur in one third of patients
7.The blood in nephrotic syndrome tend to clot easily and the patient may develop blood clots in his leg veins.
8.Lipids may be raised in the blood especially triglicerides and cholesterol
9.Symptoms and signs of underlying diseases such as diabetes, SLE etc may be present
Diagnosis:
1.A history of recent kidney infection followed by swelling of face ang legs
2.Urinary protein loss of 15g per day
3.Full examination of fresh urine for red blood cells and casts(indicating glomerulonephritis) and lipid
4.Full blood count and tests for kidney function
5.Ultrasound of kidneys
6.Biopsy of kidney and histology of specimen
Complications:
1.Renal failure
2.hemolytic uremic stndrome
Treatment should be in hospital:
1.Minimal change nephropathy in children are treated with high doses of corticosteroids up to 1mg prednisolone per kg per day.
In most cases within 10 days there should be reduction of fluid in the body with increased urinary passage of urine.
Relapses may occur and should be treated with more corticosteroids or cyclophosphamide
2.In adults treatment with corticosteroids should help to treat the edema.
3.In addition thiazide diuretics or frusemide to reduce edema.
Spironolactone and amiloride may also help
4.Hypertension may require anti hypertensive. The use of corticosteroids may aggravate hypertension.
5.Diet with low salt and protein
6.Intake of fluids are restricted
These 2 measures will reduce the strain on the kidneys and prevent accumulation of fluids
Prognosis:
1.In most cases of MCN the illness will clear up with proper treatment.
Some may have relapses.
After 3 years of remission 99% of MCN will not have relapses
MCN cases seldom progress to renal failure.
2.In focal glomerulonephritis cases nephrotic syndrome may develop into chronic renal failure.
3.In Membranous nephropathy
25% complete remission
25% improves in renal function
25% have persistent nephrotic syndrome
25% will have chronic renal failure
Friday, April 15, 2011
Wednesday, April 13, 2011
A Family Doctor's Tale -GLOMERULONEPHRITIS
DOC I HAVE GLOMERULONEPHRITIS
Glomerulonephritis is a disease characterized by the inflammation of the glomeruli, the filtering units of the kidneys.
The glomeruli are unable to function properly due to the inflammation and allows loss of blood and protein in the urine and retention of salt, water and nitrogen.
Both kidneys are affected usually.
It is not contagious.
The exact cause of Glomerulonephritis is not known.
1.It has been suggested that an autoimmune disease is the main cause of Glomerulonephritis disease.
The antibodies produced by the body to fight germs starts to attack the body's own healthy kidney tissue.
2.Sometimes Glomerulonephritis disease may follow an infection by the streptococcus bacteria or by viruses.
Symptoms of Glomerulonephritis disease:
1.Urine may show the presence of protein, red blood cells, casts.
2.less urine is passed than normal
3.swelling of the face and legs is quite common
4.high blood pressure may occur in rare cases
5.With increasing edema and nitrogen retention, headaches, nausea and vomiting may occur.
Diagnosis of Glomerulonephritis disease is made by:
1.A history of recent infection followed by swelling of face and legs
2.Urine test for blood, protein and casts
3.Full blood count and tests for kidney function
4.Blood Tests for raised ESR, anti-streptolysin titer, C reactive protein
5.Ultrasound of kidneys
6.Biopsy of kidney if required
Complications of Glomerulonephritis disease are:
1.Nephrotic syndrome
2.hemolytic uremic syndrome
3.renal failure
Treatment of Glomerulonephritis disease is by:
1.Diet with low salt and protein
2.Intake of fluids are restricted
These 2 measures will reduce the strain on the kidneys and prevent accumulation of fluids
3. antibiotics are given if the glomerulonephritis is suspected to be caused by a bacteria
4.hypertension is usually controlled with drugs until the blood pressure returns to normal
5.Corticosteroids and cytotoxic drugs have not been found to be effective against glomerulonephritis
Prognosis of Glomerulonephritis disease:
In most cases the illness will clear up with proper treatment.
In rare cases nephrotic syndrome may develop with ensuing chronic renal failure.
Glomerulonephritis is a disease characterized by the inflammation of the glomeruli, the filtering units of the kidneys.
The glomeruli are unable to function properly due to the inflammation and allows loss of blood and protein in the urine and retention of salt, water and nitrogen.
Both kidneys are affected usually.
It is not contagious.
The exact cause of Glomerulonephritis is not known.
1.It has been suggested that an autoimmune disease is the main cause of Glomerulonephritis disease.
The antibodies produced by the body to fight germs starts to attack the body's own healthy kidney tissue.
2.Sometimes Glomerulonephritis disease may follow an infection by the streptococcus bacteria or by viruses.
Symptoms of Glomerulonephritis disease:
1.Urine may show the presence of protein, red blood cells, casts.
2.less urine is passed than normal
3.swelling of the face and legs is quite common
4.high blood pressure may occur in rare cases
5.With increasing edema and nitrogen retention, headaches, nausea and vomiting may occur.
Diagnosis of Glomerulonephritis disease is made by:
1.A history of recent infection followed by swelling of face and legs
2.Urine test for blood, protein and casts
3.Full blood count and tests for kidney function
4.Blood Tests for raised ESR, anti-streptolysin titer, C reactive protein
5.Ultrasound of kidneys
6.Biopsy of kidney if required
Complications of Glomerulonephritis disease are:
1.Nephrotic syndrome
2.hemolytic uremic syndrome
3.renal failure
Treatment of Glomerulonephritis disease is by:
1.Diet with low salt and protein
2.Intake of fluids are restricted
These 2 measures will reduce the strain on the kidneys and prevent accumulation of fluids
3. antibiotics are given if the glomerulonephritis is suspected to be caused by a bacteria
4.hypertension is usually controlled with drugs until the blood pressure returns to normal
5.Corticosteroids and cytotoxic drugs have not been found to be effective against glomerulonephritis
Prognosis of Glomerulonephritis disease:
In most cases the illness will clear up with proper treatment.
In rare cases nephrotic syndrome may develop with ensuing chronic renal failure.
Monday, April 11, 2011
A Family Doctor's Tale - THREADWORMS
DOC I HAVE THREADWORMS
Thread worms are parasitic worms (also called pin worms) which are found in the intestines of children in undeveloped countries.
It is rare in developed countries because of the modern sanitary conditions and better hygiene.
Several members of the same household may be infested at the same time so all the family should be treated together.
The cause of Threadworms infection is:
Threadworms eggs or larva are present on the hands or food prepared by people who has threadworms infestations.
When the eggs or larvae are swallowed they developed into adult worms in the intestines.
The adult worms will cling on to the mucosal lining of the intestine and absorb nutrients from the food taken into the intestines by the affected person.
The female worms emerge from the rectum at night to lay their eggs on the skin around the anus.
The main symptoms of Thread worms are
1. Itch in the anal region especially at night when the worms lay the eggs.
2. Itch in the vulva in girls
3. inflammation of the anus as a result of constant scratching.
4.Rarely tiny white worms can be seen wriggling in the feces.
Doctors generally diagnose Thread worms based on:
1.sticky tape pressed to the anal area in the morning before the patient bathes or go to the toilet will collect the eggs for microscopic examination and confirmation of the presence of thread worms
2.Stool examination and culture
Treatment of thread worm infestation is by the use of anti-parasitic medicine:
1.Zentel or Abendazole 400mg in a single dose
2.Pyrantel pamoate 10mg/kg in a single dose
3.Mebendazole 100mg in a single dose
A single dose will usually cure the patient of thread worms but to prevent re-infection a second dosage is taken 2 weeks later.
All the family members should also be treated.
Prevention of thread worms is through:
1.good personal hygiene and hand washing
2. good food hygiene
Prognosis of thread worms treatment is excellent.
Thread worms are parasitic worms (also called pin worms) which are found in the intestines of children in undeveloped countries.
It is rare in developed countries because of the modern sanitary conditions and better hygiene.
Several members of the same household may be infested at the same time so all the family should be treated together.
The cause of Threadworms infection is:
Threadworms eggs or larva are present on the hands or food prepared by people who has threadworms infestations.
When the eggs or larvae are swallowed they developed into adult worms in the intestines.
The adult worms will cling on to the mucosal lining of the intestine and absorb nutrients from the food taken into the intestines by the affected person.
The female worms emerge from the rectum at night to lay their eggs on the skin around the anus.
The main symptoms of Thread worms are
1. Itch in the anal region especially at night when the worms lay the eggs.
2. Itch in the vulva in girls
3. inflammation of the anus as a result of constant scratching.
4.Rarely tiny white worms can be seen wriggling in the feces.
Doctors generally diagnose Thread worms based on:
1.sticky tape pressed to the anal area in the morning before the patient bathes or go to the toilet will collect the eggs for microscopic examination and confirmation of the presence of thread worms
2.Stool examination and culture
Treatment of thread worm infestation is by the use of anti-parasitic medicine:
1.Zentel or Abendazole 400mg in a single dose
2.Pyrantel pamoate 10mg/kg in a single dose
3.Mebendazole 100mg in a single dose
A single dose will usually cure the patient of thread worms but to prevent re-infection a second dosage is taken 2 weeks later.
All the family members should also be treated.
Prevention of thread worms is through:
1.good personal hygiene and hand washing
2. good food hygiene
Prognosis of thread worms treatment is excellent.
Sunday, April 10, 2011
A Simple Guide to Giardiasis
A Simple Guide to Giardiasis
---------------------------------
What is Giardiasis?
---------------------------
Giardiasis is an acute infectious illness caused by the single celled parasite Giardia lamblia
What is the cause of Giardiasis?
----------------------------------
The bacteria which causes Giardiasis is the Giardia lamblia
which is an extremely hardy parasite able to live in polluted water, contaminated food and soiled clothes.
Giardiasis infections occur most common in the small intestines.
The parasite can cling to folds of the lining of the small intestine and absorbs nutrients from the fluid in the intestines.
In this way the child may suffer from malnutrition.
What are symptoms of Giardiasis?
----------------------------------------------
The main symptoms of Giardiasis are
1. Many people with E.histolytica in stools are passive carrier
2. Invasive bowel disease begins 1-6 months after infection sometimes later
3. abdominal pain especially at the sides
4. altered bowel habit
5.diarrhea with blood or mucus in stools
6.foul stools
7.adominal bloating or gas
8.tenderness on palpation at caecum or sigmoid colon regions
Severe cases may have:
1.more severe symptoms as above
2.bloody stools
3.fever
4.weight loss
5.liver enlargement and tenderness on palpation
6.dehydration and its effects such as delirium and disorientation
7. lassitude and tiredness
8. convulsions
9.tender abdominal mass with obstruction
How is the diagnosis of Giardiasis made?
-----------------------------------------------------
Doctors generally diagnose Giardiasis based on:
1. stool cultures.
2.blood tests
3.colonoscopy
4.liver scan and ultrasound
What are the complications of Giardiasis?
-------------------------------------------
Giardiasis is a disease which can kill espcially through its complications:
1.Perforation of bowel leading to peritonitis or inta-abdominal abscesses
2.Severe hemorrhage uncommon but can cause death
3.Intussusception or insertion of part of colon into another part of colon is rare but can follow amebic ulceration and may cause intestinal obstruction
4.irritable bowel syndrome may persist for some months
5.Lung and pericardial involvement rare but can pose danger
6. cutaneous amebiasis cause deep painful and rapidly spreading ulceration
7.Liver infection can cause damage to liver and result in cirrhosis
8.Liver abscess may perforate and cause peritonitis or produce lung abscess or amebic pericarditis
9.Amebic brain abscess are rare but can occur.
How is Giardiasis treated?
-------------------------------------
Giardiasis is an infectious disease which can spread to other people through contaminated food and water.
1.Anti-parasitic medicines like metronidazole 750mg three times a day for 10 days should work for mild to moderate disease.
2.Metronidazole 750mg three times a day for 10 days and chloroquine or diiodohydroquin (1000mg for 2 days followed by 500mg per day up to 3 weeks) for hepatic amebiosis
3.Emetine hydrochloride 1mg pere kg per day by intramuscular injections for 5 days in acute amebic dysenery
4.tetracycline 250mg four times a day for 10 days my be needed for some with invasive intestinal disease.
5.Diloxanide furoate 500mg three a day for 10 days for asymptomatic amebic cyst carrier
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to harden the stools such as kaolin
4.slow down the intestinal movement (lomotil or loperamide).
Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
Get plenty of rest.
How is Giardiasis prevented?
----------------------------------------
Prevention of Giardiasis can be by:
1.boil drinking and cooking water for 5 minutes
2.Proper filtration of water
3.Examination of stools of food handlers
4.Avoid eating or drinking foods or liquids that might be contaminated especially by flies
5.Good food hygience and hand washing
What is the prognosis of Giardiasis?
-------------------------------------
Prognosis depends on the stage of disease
It is excellent with prompt treatment of amebic infection.
Luminal disease or dysentery usually respond well to treatment.
In refractory cases chloroquine may be added to metronidazole.
Surgery is rarely necessary.
---------------------------------
What is Giardiasis?
---------------------------
Giardiasis is an acute infectious illness caused by the single celled parasite Giardia lamblia
What is the cause of Giardiasis?
----------------------------------
The bacteria which causes Giardiasis is the Giardia lamblia
which is an extremely hardy parasite able to live in polluted water, contaminated food and soiled clothes.
Giardiasis infections occur most common in the small intestines.
The parasite can cling to folds of the lining of the small intestine and absorbs nutrients from the fluid in the intestines.
In this way the child may suffer from malnutrition.
What are symptoms of Giardiasis?
----------------------------------------------
The main symptoms of Giardiasis are
1. Many people with E.histolytica in stools are passive carrier
2. Invasive bowel disease begins 1-6 months after infection sometimes later
3. abdominal pain especially at the sides
4. altered bowel habit
5.diarrhea with blood or mucus in stools
6.foul stools
7.adominal bloating or gas
8.tenderness on palpation at caecum or sigmoid colon regions
Severe cases may have:
1.more severe symptoms as above
2.bloody stools
3.fever
4.weight loss
5.liver enlargement and tenderness on palpation
6.dehydration and its effects such as delirium and disorientation
7. lassitude and tiredness
8. convulsions
9.tender abdominal mass with obstruction
How is the diagnosis of Giardiasis made?
-----------------------------------------------------
Doctors generally diagnose Giardiasis based on:
1. stool cultures.
2.blood tests
3.colonoscopy
4.liver scan and ultrasound
What are the complications of Giardiasis?
-------------------------------------------
Giardiasis is a disease which can kill espcially through its complications:
1.Perforation of bowel leading to peritonitis or inta-abdominal abscesses
2.Severe hemorrhage uncommon but can cause death
3.Intussusception or insertion of part of colon into another part of colon is rare but can follow amebic ulceration and may cause intestinal obstruction
4.irritable bowel syndrome may persist for some months
5.Lung and pericardial involvement rare but can pose danger
6. cutaneous amebiasis cause deep painful and rapidly spreading ulceration
7.Liver infection can cause damage to liver and result in cirrhosis
8.Liver abscess may perforate and cause peritonitis or produce lung abscess or amebic pericarditis
9.Amebic brain abscess are rare but can occur.
How is Giardiasis treated?
-------------------------------------
Giardiasis is an infectious disease which can spread to other people through contaminated food and water.
1.Anti-parasitic medicines like metronidazole 750mg three times a day for 10 days should work for mild to moderate disease.
2.Metronidazole 750mg three times a day for 10 days and chloroquine or diiodohydroquin (1000mg for 2 days followed by 500mg per day up to 3 weeks) for hepatic amebiosis
3.Emetine hydrochloride 1mg pere kg per day by intramuscular injections for 5 days in acute amebic dysenery
4.tetracycline 250mg four times a day for 10 days my be needed for some with invasive intestinal disease.
5.Diloxanide furoate 500mg three a day for 10 days for asymptomatic amebic cyst carrier
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to harden the stools such as kaolin
4.slow down the intestinal movement (lomotil or loperamide).
Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
Get plenty of rest.
How is Giardiasis prevented?
----------------------------------------
Prevention of Giardiasis can be by:
1.boil drinking and cooking water for 5 minutes
2.Proper filtration of water
3.Examination of stools of food handlers
4.Avoid eating or drinking foods or liquids that might be contaminated especially by flies
5.Good food hygience and hand washing
What is the prognosis of Giardiasis?
-------------------------------------
Prognosis depends on the stage of disease
It is excellent with prompt treatment of amebic infection.
Luminal disease or dysentery usually respond well to treatment.
In refractory cases chloroquine may be added to metronidazole.
Surgery is rarely necessary.
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