This document provides information on evaluating and approaching a case of nephrotic syndrome. It defines key terms like proteinuria and nephrotic syndrome. It describes the normal physiology of protein filtration and reabsorption in the kidneys. It also classifies and discusses different types of proteinuria including tubular proteinuria, glomerular proteinuria, and microalbuminuria. The document outlines the initial workup and further investigations for a patient with proteinuria. It concludes by covering the causes, pathophysiology, and specific investigations for nephrotic syndrome.
This document provides information on proteinuria (abnormal amounts of protein in the urine) including its history, physiology, detection, quantification, causes, and diagnostic evaluation. It details the normal mechanisms by which the kidneys filter and reabsorb albumin and other proteins from the blood. Common causes of proteinuria include benign causes like exercise as well as pathological glomerular, tubular, and overflow proteinuria due to various kidney diseases and disorders. The diagnostic approach involves urinalysis, urine protein creatinine ratio, and ruling out transient causes through repeated testing.
This document discusses polyuria, which is excessive urine output of greater than 3 liters per day in adults. Polyuria can be caused by physiological factors like excessive fluid intake or anxiety, or pathological factors like endocrine, renal, or psychiatric conditions. It may occur due to increased solute excretion (solute diuresis) or increased water excretion due to a defect in ADH production or renal responsiveness (water diuresis). Other conditions discussed include proteinuria, hematuria, and urinary retention. Causes, diagnostic testing, and treatment approaches are provided for each condition.
Evaluation of proteinuria in children pptShane Watson
The document discusses the glomerular filtration barrier and the mechanisms of proteinuria. It defines normal levels of urinary protein excretion in children and describes different types of proteinuria including glomerular, tubular, and overflow proteinuria. Evaluation and workup of asymptomatic proteinuria is outlined including orthostatic testing, urine dipstick, and quantitative urine protein levels. Management depends on the type and severity of proteinuria.
- A 54-year-old male with a blood pressure of 110/70 mg and 24-hour urinary protein of 180 mg is being evaluated as a kidney donor for his sister. His 24-hour creatinine clearance is 85mL/min.
- Normal urinary protein excretion is defined as less than 150 mg per day. The patient's proteinuria is in the non-nephrotic range of less than 3.5 g per day.
- Various factors like transient causes, tubular disorders, and monoclonal gammopathies can cause different types of isolated or mixed proteinuria. Accurately measuring and characterizing proteinuria is important for evaluating kidney function and disease.
Proteinuria refers to excess protein in the urine. Normally less than 150 mg of protein is excreted in urine per day, mostly albumin and Tamm-Horsfall protein. Proteinuria can be caused by glomerular disease resulting in abnormal permeability of the glomerular basement membrane, overflow of small proteins in the blood, or tubular disease impairing reabsorption. Persistent proteinuria over 3.5 g per day usually indicates glomerular disease and is a predictor of progressive chronic kidney disease, with the rate of renal function decline proportional to the severity of proteinuria.
The document discusses proteinuria and hematuria in children. It covers the definition, causes, evaluation, and treatment of both conditions. Proteinuria can be caused by glomerular, tubular, or overflow mechanisms and is evaluated through urine dipsticks, 24-hour urine collection, and urine protein to creatinine ratio. Hematuria can be gross or microscopic and is seen in conditions like UTI, nephrolithiasis, glomerulonephritis, IgA nephropathy, and Alport syndrome. Evaluation of hematuria involves urinalysis, urine culture, imaging, and considering familial causes. Specific renal diseases like post-streptococcal glomerulonephritis
- Nephrotic syndrome is defined as protein excretion greater than 3.5 g/24 hours, hypoalbuminemia less than 3.0 g/dL, and peripheral edema.
- Common causes include minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy. Secondary causes can be due to diseases like diabetes, lupus, amyloidosis.
- Metabolic consequences of nephrotic syndrome include hyperlipidemia, risk of infection due to urinary protein losses, hypocalcemia, hypercoagulability, and hypovolemia with severe hypoalbuminemia.
Proteinuria provides diagnostic and prognostic information about renal disease. It is associated with hypertension, obesity, and vascular disease, and can predict risks of chronic kidney disease progression, cardiovascular disease, and mortality. Monitoring proteinuria is important for assessing treatment response, as protein-lowering therapies may be renoprotective. A thorough history, physical exam, urinalysis, and further tests are needed to determine the type and cause of proteinuria and rule out underlying conditions in order to begin appropriate treatment.
This document provides information on proteinuria (abnormal amounts of protein in the urine) including its history, physiology, detection, quantification, causes, and diagnostic evaluation. It details the normal mechanisms by which the kidneys filter and reabsorb albumin and other proteins from the blood. Common causes of proteinuria include benign causes like exercise as well as pathological glomerular, tubular, and overflow proteinuria due to various kidney diseases and disorders. The diagnostic approach involves urinalysis, urine protein creatinine ratio, and ruling out transient causes through repeated testing.
This document discusses polyuria, which is excessive urine output of greater than 3 liters per day in adults. Polyuria can be caused by physiological factors like excessive fluid intake or anxiety, or pathological factors like endocrine, renal, or psychiatric conditions. It may occur due to increased solute excretion (solute diuresis) or increased water excretion due to a defect in ADH production or renal responsiveness (water diuresis). Other conditions discussed include proteinuria, hematuria, and urinary retention. Causes, diagnostic testing, and treatment approaches are provided for each condition.
Evaluation of proteinuria in children pptShane Watson
The document discusses the glomerular filtration barrier and the mechanisms of proteinuria. It defines normal levels of urinary protein excretion in children and describes different types of proteinuria including glomerular, tubular, and overflow proteinuria. Evaluation and workup of asymptomatic proteinuria is outlined including orthostatic testing, urine dipstick, and quantitative urine protein levels. Management depends on the type and severity of proteinuria.
- A 54-year-old male with a blood pressure of 110/70 mg and 24-hour urinary protein of 180 mg is being evaluated as a kidney donor for his sister. His 24-hour creatinine clearance is 85mL/min.
- Normal urinary protein excretion is defined as less than 150 mg per day. The patient's proteinuria is in the non-nephrotic range of less than 3.5 g per day.
- Various factors like transient causes, tubular disorders, and monoclonal gammopathies can cause different types of isolated or mixed proteinuria. Accurately measuring and characterizing proteinuria is important for evaluating kidney function and disease.
Proteinuria refers to excess protein in the urine. Normally less than 150 mg of protein is excreted in urine per day, mostly albumin and Tamm-Horsfall protein. Proteinuria can be caused by glomerular disease resulting in abnormal permeability of the glomerular basement membrane, overflow of small proteins in the blood, or tubular disease impairing reabsorption. Persistent proteinuria over 3.5 g per day usually indicates glomerular disease and is a predictor of progressive chronic kidney disease, with the rate of renal function decline proportional to the severity of proteinuria.
The document discusses proteinuria and hematuria in children. It covers the definition, causes, evaluation, and treatment of both conditions. Proteinuria can be caused by glomerular, tubular, or overflow mechanisms and is evaluated through urine dipsticks, 24-hour urine collection, and urine protein to creatinine ratio. Hematuria can be gross or microscopic and is seen in conditions like UTI, nephrolithiasis, glomerulonephritis, IgA nephropathy, and Alport syndrome. Evaluation of hematuria involves urinalysis, urine culture, imaging, and considering familial causes. Specific renal diseases like post-streptococcal glomerulonephritis
- Nephrotic syndrome is defined as protein excretion greater than 3.5 g/24 hours, hypoalbuminemia less than 3.0 g/dL, and peripheral edema.
- Common causes include minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy. Secondary causes can be due to diseases like diabetes, lupus, amyloidosis.
- Metabolic consequences of nephrotic syndrome include hyperlipidemia, risk of infection due to urinary protein losses, hypocalcemia, hypercoagulability, and hypovolemia with severe hypoalbuminemia.
Proteinuria provides diagnostic and prognostic information about renal disease. It is associated with hypertension, obesity, and vascular disease, and can predict risks of chronic kidney disease progression, cardiovascular disease, and mortality. Monitoring proteinuria is important for assessing treatment response, as protein-lowering therapies may be renoprotective. A thorough history, physical exam, urinalysis, and further tests are needed to determine the type and cause of proteinuria and rule out underlying conditions in order to begin appropriate treatment.
This document provides information about urinalysis, including indications for testing urine, sample collection methods, changes that occur in standing urine, preservation of samples, and the various examinations performed - physical, chemical, and microscopic. The physical examination assesses properties like volume, color, appearance, odor, specific gravity, and pH. The chemical examination tests for proteins, glucose, ketones, bilirubin, and other substances. Microscopic examination analyzes urine sediment. Proper collection and handling of urine samples is important for obtaining accurate test results.
1. The document provides an overview of renal anatomy and physiology, clinical manifestations of renal diseases, methods for estimating renal function, and common renal disease syndromes.
2. Key aspects of renal anatomy discussed include the structure and function of nephrons, the glomerular filtration barrier, and countercurrent exchange mechanisms.
3. Common clinical signs of renal diseases include edema, hypertension, flank pain, urinary abnormalities, and changes in estimated glomerular filtration rate.
4. Major renal disease syndromes covered are nephrotic syndrome, nephritic syndrome, acute renal failure, and chronic renal failure.
Glomerular diseases can be classified as either primary (intrinsic renal pathology) or secondary (to a systemic disease). They present clinically with nephritic syndrome (hematuria, hypertension, azotemia) or nephrotic syndrome (proteinuria, edema, hypoalbuminemia, hyperlipidemia). The pathophysiology depends on which part of the glomerular structure is affected - podocyte damage leads to nephrotic syndrome with proteinuria alone, while damage to endothelial cells, GBM or mesangial cells causes nephritic syndrome with hematuria and proteinuria. Common primary glomerular diseases include minimal change disease, focal segmental glomerulosclerosis, membranous glomerulone
Urinalysis for detection of abnormal constituentsrohini sane
An illustrative presentation on Urinalysis for detection of abnormal constituents for medical ,dental , pharmacology and biotechnology students to facilitate easy-learning.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Proteinuria - Mechanisms , Causes and Approach.pdfJim Jacob Roy
Proteinuria can occur due to various reasons.
The normal urinary excretion of protein is less than 150 mg / day.
If the daily excretion rate is > 3.5 g / day , it is termed as nephrotic range proteinuria.
In this document , I have described about the mechanisms of proteinuria , the methods to measure urinary protein and the various causes of proteinuria.
This document provides an overview of acute renal failure (ARF). It defines ARF as a sudden decline in renal function associated with increased BUN and creatinine and oliguria. ARF can be pre-renal, post-renal, or intra-renal in origin. Clinical manifestations include fluid overload, electrolyte imbalances, and declining kidney function. Treatment involves addressing the underlying cause, fluid hydration, diuretics, and possibly dialysis. Nursing care focuses on monitoring fluid balance and labs, preventing complications like infection, and supporting the patient.
This document provides an overview of approaches to evaluating and managing proteinuria. It discusses normal urinary protein excretion and defines different types of proteinuria. Transient, orthostatic, and persistent proteinuria are described along with pathological causes. Evaluation of a patient with proteinuria involves taking a thorough history, physical exam, and lab tests. Total urinary protein can be measured quantitatively through 24-hour urine collection or spot urine protein/creatinine ratio. Management focuses on controlling blood pressure and glycemia as well as lipid levels. Specific therapies may be used depending on the underlying cause of proteinuria.
This document provides an overview of approaches to proteinuria. It discusses normal urinary protein excretion and defines different types of proteinuria. It describes the evaluation of patients with proteinuria including relevant history, exam findings, and lab tests. It also covers detection and measurement of urinary protein. Management involves controlling blood pressure and lipids. The prognosis depends on the underlying cause, with diabetic nephropathy typically progressing to kidney failure over 10-20 years and nephrotic syndrome having a more variable prognosis.
Nephrotic and nephritic Syndrome children 7.pptArun170190
This document discusses nephrotic syndrome and nephritic syndrome. It begins by defining nephrotic syndrome as having massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia due to increased permeability of the glomeruli. Nephritic syndrome is defined as having hematuria, proteinuria less than 3g/day, hypertension, and oliguria due to thin glomerular basement membranes allowing protein and blood into the tubules. The document then covers pathogenesis, clinical manifestations, investigations including urine analysis and renal biopsy, differential diagnosis, treatment including corticosteroids and immunosuppression, and complications of both nephrotic and nephritic syndrome.
1. Urine analysis provides important information about renal and metabolic function through physical, chemical, and microscopic examination of urine samples.
2. Physical examination assesses attributes like volume, color, clarity, odor, specific gravity, pH, and other properties. Chemical examination tests for substances like proteins, glucose, ketones, bilirubin and more. Microscopic examination analyzes cellular and formed elements in urine.
3. Proper collection, preservation and timely testing of urine samples is necessary to obtain accurate results and detect abnormalities that can indicate underlying diseases.
The document discusses kidney function tests. It describes the purpose of urine examination to diagnose kidney disorders and other diseases affecting kidney function. It covers macroscopic examination of urine including color, odor, pH, specific gravity and volume. Microscopic examination looks at cells, crystals, casts and microorganisms. Chemical examination tests for proteins, sugars, ketones, bile salts and blood. Clearance tests and urine concentration tests assess renal tubular function. Different types of kidney stones are also discussed.
Nephrotic syndrome is a kidney disorder characterized by heavy protein in the urine, low blood protein levels, fluid retention causing edema, and high cholesterol. It is caused by damage to the glomeruli in the kidneys, which allows protein to pass into the urine. Common causes include infections, cancers, autoimmune diseases, medications, and genetic factors. Symptoms include generalized edema, fatigue, loss of appetite, and shortness of breath. Diagnosis involves blood and urine tests to detect low protein and high protein in the urine. Treatment focuses on reducing edema with diuretics, lowering blood pressure and proteinuria with ACE inhibitors, and using steroids to reduce inflammation in some cases.
This document discusses proteinuria in children. It begins by defining normal protein excretion levels in children and the kidney's role in filtering and reabsorbing proteins. It then covers causes of increased protein excretion including glomerular dysfunction and tubular reabsorption issues. Case studies are presented to demonstrate evaluating and differentiating between normal and abnormal proteinuria. Nephrotic syndrome is defined as massive proteinuria and causes such as minimal change disease are discussed. Complications include infections while treatment focuses on steroids, immunosuppressants, and managing symptoms.
Glomerular diseases in children commonly manifest as nephrotic syndrome. The nephrotic syndrome is characterized by edema, high cholesterol, low albumin, and severe protein in the urine. The most common cause is minimal-change disease, which typically responds well to corticosteroid therapy. Complications can include infections, electrolyte imbalances, and blood clotting issues. Treatment involves dietary changes, diuretics, antibiotics for infections, and corticosteroids as the primary therapy, with cytotoxic drugs used for resistant cases. Prognosis depends on the underlying histology, with minimal-change disease having a good long-term outlook in most cases.
Nephrotic syndrome is a condition characterized by edema, massive proteinuria, hyperlipidemia, and hypoalbuminemia. It is most common in children ages 2-6 years old and boys. Nephrotic syndrome can be primary, caused by diseases affecting only the kidneys, or secondary, caused by conditions that impact other organs like infections, diabetes, or cancers. In nephrotic syndrome, the glomeruli in the kidneys are damaged, allowing proteins to pass into the urine. This causes edema, high cholesterol, and other issues. Management focuses on monitoring fluids, nutrition, preventing infection, and treatments like steroids, diuretics, or immunosuppressants. Complications can include
This document discusses renal function tests and their importance in assessing kidney function and detecting impairment. It describes various tests including urine analysis, blood tests of creatinine and urea, and glomerular function tests. Common indications for evaluating renal function are listed, such as older age, diabetes, and hypertension. The document also outlines approaches to interpreting test results and diagnosing different kidney conditions like acute injury, nephritic syndrome, and nephrotic syndrome.
Approach to the Patient with Renal DiseasePatrick Carter
This document provides an overview of renal disease for medical students. It defines key terms related to renal function and urine findings. It describes tools for detecting renal disease including history, physical exam, urinalysis, and bloodwork. It discusses uremic syndrome and its effects on multiple organ systems. It differentiates between acute and chronic renal failure, nephritic and nephrotic syndrome based on causes, labs, and physical findings. The goal is to review approaches for evaluating and classifying patients with possible renal disease.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
This document provides information about urinalysis, including indications for testing urine, sample collection methods, changes that occur in standing urine, preservation of samples, and the various examinations performed - physical, chemical, and microscopic. The physical examination assesses properties like volume, color, appearance, odor, specific gravity, and pH. The chemical examination tests for proteins, glucose, ketones, bilirubin, and other substances. Microscopic examination analyzes urine sediment. Proper collection and handling of urine samples is important for obtaining accurate test results.
1. The document provides an overview of renal anatomy and physiology, clinical manifestations of renal diseases, methods for estimating renal function, and common renal disease syndromes.
2. Key aspects of renal anatomy discussed include the structure and function of nephrons, the glomerular filtration barrier, and countercurrent exchange mechanisms.
3. Common clinical signs of renal diseases include edema, hypertension, flank pain, urinary abnormalities, and changes in estimated glomerular filtration rate.
4. Major renal disease syndromes covered are nephrotic syndrome, nephritic syndrome, acute renal failure, and chronic renal failure.
Glomerular diseases can be classified as either primary (intrinsic renal pathology) or secondary (to a systemic disease). They present clinically with nephritic syndrome (hematuria, hypertension, azotemia) or nephrotic syndrome (proteinuria, edema, hypoalbuminemia, hyperlipidemia). The pathophysiology depends on which part of the glomerular structure is affected - podocyte damage leads to nephrotic syndrome with proteinuria alone, while damage to endothelial cells, GBM or mesangial cells causes nephritic syndrome with hematuria and proteinuria. Common primary glomerular diseases include minimal change disease, focal segmental glomerulosclerosis, membranous glomerulone
Urinalysis for detection of abnormal constituentsrohini sane
An illustrative presentation on Urinalysis for detection of abnormal constituents for medical ,dental , pharmacology and biotechnology students to facilitate easy-learning.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Proteinuria - Mechanisms , Causes and Approach.pdfJim Jacob Roy
Proteinuria can occur due to various reasons.
The normal urinary excretion of protein is less than 150 mg / day.
If the daily excretion rate is > 3.5 g / day , it is termed as nephrotic range proteinuria.
In this document , I have described about the mechanisms of proteinuria , the methods to measure urinary protein and the various causes of proteinuria.
This document provides an overview of acute renal failure (ARF). It defines ARF as a sudden decline in renal function associated with increased BUN and creatinine and oliguria. ARF can be pre-renal, post-renal, or intra-renal in origin. Clinical manifestations include fluid overload, electrolyte imbalances, and declining kidney function. Treatment involves addressing the underlying cause, fluid hydration, diuretics, and possibly dialysis. Nursing care focuses on monitoring fluid balance and labs, preventing complications like infection, and supporting the patient.
This document provides an overview of approaches to evaluating and managing proteinuria. It discusses normal urinary protein excretion and defines different types of proteinuria. Transient, orthostatic, and persistent proteinuria are described along with pathological causes. Evaluation of a patient with proteinuria involves taking a thorough history, physical exam, and lab tests. Total urinary protein can be measured quantitatively through 24-hour urine collection or spot urine protein/creatinine ratio. Management focuses on controlling blood pressure and glycemia as well as lipid levels. Specific therapies may be used depending on the underlying cause of proteinuria.
This document provides an overview of approaches to proteinuria. It discusses normal urinary protein excretion and defines different types of proteinuria. It describes the evaluation of patients with proteinuria including relevant history, exam findings, and lab tests. It also covers detection and measurement of urinary protein. Management involves controlling blood pressure and lipids. The prognosis depends on the underlying cause, with diabetic nephropathy typically progressing to kidney failure over 10-20 years and nephrotic syndrome having a more variable prognosis.
Nephrotic and nephritic Syndrome children 7.pptArun170190
This document discusses nephrotic syndrome and nephritic syndrome. It begins by defining nephrotic syndrome as having massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia due to increased permeability of the glomeruli. Nephritic syndrome is defined as having hematuria, proteinuria less than 3g/day, hypertension, and oliguria due to thin glomerular basement membranes allowing protein and blood into the tubules. The document then covers pathogenesis, clinical manifestations, investigations including urine analysis and renal biopsy, differential diagnosis, treatment including corticosteroids and immunosuppression, and complications of both nephrotic and nephritic syndrome.
1. Urine analysis provides important information about renal and metabolic function through physical, chemical, and microscopic examination of urine samples.
2. Physical examination assesses attributes like volume, color, clarity, odor, specific gravity, pH, and other properties. Chemical examination tests for substances like proteins, glucose, ketones, bilirubin and more. Microscopic examination analyzes cellular and formed elements in urine.
3. Proper collection, preservation and timely testing of urine samples is necessary to obtain accurate results and detect abnormalities that can indicate underlying diseases.
The document discusses kidney function tests. It describes the purpose of urine examination to diagnose kidney disorders and other diseases affecting kidney function. It covers macroscopic examination of urine including color, odor, pH, specific gravity and volume. Microscopic examination looks at cells, crystals, casts and microorganisms. Chemical examination tests for proteins, sugars, ketones, bile salts and blood. Clearance tests and urine concentration tests assess renal tubular function. Different types of kidney stones are also discussed.
Nephrotic syndrome is a kidney disorder characterized by heavy protein in the urine, low blood protein levels, fluid retention causing edema, and high cholesterol. It is caused by damage to the glomeruli in the kidneys, which allows protein to pass into the urine. Common causes include infections, cancers, autoimmune diseases, medications, and genetic factors. Symptoms include generalized edema, fatigue, loss of appetite, and shortness of breath. Diagnosis involves blood and urine tests to detect low protein and high protein in the urine. Treatment focuses on reducing edema with diuretics, lowering blood pressure and proteinuria with ACE inhibitors, and using steroids to reduce inflammation in some cases.
This document discusses proteinuria in children. It begins by defining normal protein excretion levels in children and the kidney's role in filtering and reabsorbing proteins. It then covers causes of increased protein excretion including glomerular dysfunction and tubular reabsorption issues. Case studies are presented to demonstrate evaluating and differentiating between normal and abnormal proteinuria. Nephrotic syndrome is defined as massive proteinuria and causes such as minimal change disease are discussed. Complications include infections while treatment focuses on steroids, immunosuppressants, and managing symptoms.
Glomerular diseases in children commonly manifest as nephrotic syndrome. The nephrotic syndrome is characterized by edema, high cholesterol, low albumin, and severe protein in the urine. The most common cause is minimal-change disease, which typically responds well to corticosteroid therapy. Complications can include infections, electrolyte imbalances, and blood clotting issues. Treatment involves dietary changes, diuretics, antibiotics for infections, and corticosteroids as the primary therapy, with cytotoxic drugs used for resistant cases. Prognosis depends on the underlying histology, with minimal-change disease having a good long-term outlook in most cases.
Nephrotic syndrome is a condition characterized by edema, massive proteinuria, hyperlipidemia, and hypoalbuminemia. It is most common in children ages 2-6 years old and boys. Nephrotic syndrome can be primary, caused by diseases affecting only the kidneys, or secondary, caused by conditions that impact other organs like infections, diabetes, or cancers. In nephrotic syndrome, the glomeruli in the kidneys are damaged, allowing proteins to pass into the urine. This causes edema, high cholesterol, and other issues. Management focuses on monitoring fluids, nutrition, preventing infection, and treatments like steroids, diuretics, or immunosuppressants. Complications can include
This document discusses renal function tests and their importance in assessing kidney function and detecting impairment. It describes various tests including urine analysis, blood tests of creatinine and urea, and glomerular function tests. Common indications for evaluating renal function are listed, such as older age, diabetes, and hypertension. The document also outlines approaches to interpreting test results and diagnosing different kidney conditions like acute injury, nephritic syndrome, and nephrotic syndrome.
Approach to the Patient with Renal DiseasePatrick Carter
This document provides an overview of renal disease for medical students. It defines key terms related to renal function and urine findings. It describes tools for detecting renal disease including history, physical exam, urinalysis, and bloodwork. It discusses uremic syndrome and its effects on multiple organ systems. It differentiates between acute and chronic renal failure, nephritic and nephrotic syndrome based on causes, labs, and physical findings. The goal is to review approaches for evaluating and classifying patients with possible renal disease.
Similar to Nephrotic syndrome sharanpur 2022 .ppt (20)
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
1. Approach to a case of
Nephrotic Syndrome
Dr Sandeep Kumar Garg
MD DM
Nephrologist, Dialysis Expert
Renal transplant physician
Fellow in critical care medicine
NUTEMA HOSPITAL
Meerut
2.
3. Proteinuria and Nephrotic syndrome
Definitions
Physiology
Physiological proteinuria
Classification of proteinuria
Urine dipstick
Investigation of proteinuria
Nephrotic syndrome
4. Definitions
Proteinuria
Urine protein excretion > 150mg/day
Microalbuminuria
Urine [albumin] > 30mg/day but not detectable
by urine dipstick
Nephrotic syndrome
Urine protein excretion > 3.5g/day (with
hypoalbuminaemia, oedema and
hyperlipidaemia)
5. Normal physiology
Protein filtration through the glomerulus is
dependent on the protein size, shape and
electrical charge
6. Normal physiology
Protein charge
At physiological pH, most proteins are
negatively charged
Since the basement membranes are also
negatively charged, most proteins are
retained
7. Normal physiology
Protein size
Proteins greater than 40kDa are almost
completely retained
Thus, only small proteins, e.g. retinol-binding
protein, ß2 microglobulin, passes into the
ultrafiltrate
8. Normal physiology
However, most of the filtered proteins are
reabsorbed by the proximal tubules.
Consequently, very little plasma protein
appears in the urine
Normally < 150mg/24hours
9. “Physiological” proteinuria
In some non-pathological situations, a
higher than normal urine protein level is
found:
A concentrated spot urine
Exercise
Orthostatic proteinuria
Contamination e.g. from vagina
12. Tubular proteinuria
This occurs when glomerular function is
intact, but protein is lost to the urine either
because of:
Tubular dysfunction
Overflow
13. Tubular proteinuria
Tubular dysfunction
The tubules are damaged and cannot function
properly
Therefore, the small MW proteins that are
normally filtered are not reabsorbed by the
tubules
The small MW proteins include: retinol-
binding protein, ß2 microglobulin, lysozyme,
light chains, haemoglobin, myoglobin
14. Tubular proteinuria
Tubular dysfunction
Pyelonephritis
Acute tubular necrosis
Papillary necrosis e.g. analgesic nephropathy
Heavy metal poisoning
SLE
Fanconi’s syndrome
15. Tubular proteinuria
Overflow proteinuria
Occurs when the concentration of one of the
small MW proteins is so high that the filtered
load exceeds the tubular reabsorptive
capacity
Thus, the excess filtered load appears in the
urine
19. Glomerular proteinuria
Selective proteinuria
If only intermediate-sized (< 100kDa) proteins
(albumin, transferrin), leaks through the
glomerulus, this is termed selective
proteinuria
20. Glomerular proteinuria
Non-selective proteinuria
When a range of different sized proteins leak
through including larger proteins (IgG), this is
termed non-selective proteinuria
21. Glomerular proteinuria
Selectivity
The measurement of the selectivity of
proteinuria used to be popular, however,
this has been replaced by renal biopsy
and electron microscopy
24. Microalbuminuria
Normal urine protein: 150mg/day
About 15-20 mg of the normal urine
protein is albumin
Urine dipsticks detects urine albumin
>300mg/day
27. Microalbuminuria
Clinical significance:
Correlates with mortality in diabetics and
hypertensives
Predicts the development of nephropathy in
Type 1 and Type 2 diabetes
28. Microalbuminuria
Treatment:
Good BP control, especially by ACE-inhibitors
And
Good diabetic control
Postpones the development of diabetic
nephropathy
29. Urine dipstick
Commonly used for screening of
proteinuria
Is a plastic strip impregnated with a pH
indicator which changes colour in the
presence of proteins, due to a pH change
30. Urine dipstick
The intensity of the colour correlates with
the concentration of protein in the urine
Mainly detects albumin, and therefore
glomerular proteinuria
Sensitivity: 0.1g/l
31. Urine dipstick
False positives:
When urine is alkaline (some UTI)
The urine is pigmented (haematuria)
The urine is concentrated
Drug / chemical interference (chlorhexidine)
Contamination with vaginal secretions
Addition of egg white
33. Approach to proteinuria
Proteinuria usually presents:
Incidentally upon urine dipstick testing
Or
When a patient presents with a condition
which is associated with proteinuria
34. Approach to proteinuria
Clinical history
Physical examination
Initial investigation
Further investigation
35. Clinical history
Incidental finding
Evidence of renal disease
Evidence of systemic illness
Family history of renal disease
Medications being taken
37. Initial investigation
If renal function is normal
and
If protein is trace or 1+
and
There is no significant clinical history
then
Repeat testing
38. Initial investigation
When urine dipstick is repeated, ask the
patient to:
Refrain from exercise for few hours
Collect early morning urine to exclude
orthostatic proteinuria
39. Initial investigation
If the findings are negative upon repeat
testing, then the initial positive result may
be due to a transient proteinuria (e.g.
fever, exercise)
Or
A false positive
40. Further investigation
Further investigation is needed if:
Still positive upon repeat testing
Positive clinical history
Abnormal renal function
Initial urine protein is > 1+
41. Further investigation
24 hour urine protein excretion
Creatinine and creatinine clearance
Urine microscopy
Other relevant tests dependent on the
provisional diagnosis
42. 24 hour urine protein excretion
Gives a more accurate assessment of the
severity of the proteinuria
> 150mg/24 hour = proteinuria
> 3.5 g/24 hour (with associated features)
= nephrotic syndrome
For estimation of 24hr urine albumin if
suspect microalbuminuria
43. Creatinine and creatinine clearance
And estimation of GFR
Assesses severity of renal dysfunction
44. Urine microscopy
To look for casts, white cells and red cells
May be a clue to the diagnosis of
glomerulonephritis, pyelonephritis, tubular
damage
45. Other tests
Renal ultrasound if suspect renal disease
Renal biopsy if suspect glomerular
disease
Plasma and urine electrophoresis if
suspect multiple myeloma with Bence
Jones proteinuria
Urine for myoglobin / haemoglobin
HbA1c to assess diabetic control
47. Nephrotic syndrome
Definition
Heavy proteinuria (>3.5g/day)
Generalised oedema
Hypoalbuminaemia
Hyperlipidaemia
(renal function tests can be normal or
abnormal)
50. Nephrotic syndrome
The above causes result in glomerular
proteinuria
Heavy urinary loss of proteins, including
albumin, results in hypoalbuminaemia
51. Nephrotic syndrome
Reduced blood albumin level results in
decreased intravascular oncotic pressure,
thus oedema develops
Loss of fluid from the intravascular
compartment, causes activation of RAS,
which stimulates salt and water retention
and thus, worsens the oedema
52. Nephrotic syndrome
Most proteins are lost to the urine, except
the very large proteins, e.g. lipoprotein
Due to hypoproteinaemia, the liver
increases rate of protein synthesis
53. Nephrotic syndrome
For most proteins, the increased hepatic
synthesis cannot fully compensate for the
severe urine loss
But for lipoproteins, since it is retained and
in addition to the increased hepatic
synthesis, hyperlipoproteinaemia results
54. Nephrotic syndrome
As for the loss of other proteins, there is
loss of anti-coagulants such as
antithrombin III, and thus nephrotic
syndrome could be complicated by
thromboembolic disorders, such as renal
vein thrombosis
55. Nephrotic syndrome
There is also loss of immunoglobulins, and
thus, immunodeficiency of IgG may result
56. Investigation of Nephrotic syndrome
Serum electrolytes, protein and lipid profile
Serum urea and creatinine
24hr urine protein excretion
Creatinine clearance
Urine microscopy
Renal biopsy
Investigation for systemic illness
57. Investigation of Nephrotic syndrome
Exception to renal biopsy:
Children presenting with nephrotic syndrome
are most commonly due to minimal change
disease
Readily responds to steroid
Therefore, give empirical steroid treatment
Preform renal biopsy when no reponse to
steroid treatment
58. Proteinuria
Must know:
Definitions
Significance of microalbuminuria
Approach to investigation
Dipsticks
Pathophysiology of nephrotic syndrome