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Disorders OF KIDNEY AND URINARY TRACT

Disorders OF KIDNEY AND URINARY TRACT. Dr. Shreedhar Paudel 12 April, 2009. Disorders OF KIDNEY AND URINARY TRACT. INTRODUCTION REVIEW OF ANATOMY PHYSIOLOGY OF KIDNEY APPROACH TO KIDNEY DISEASES AGE AT EVALUATION: NEONATE- MULTICYSTIC RENAL DYSPLASIA

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Disorders OF KIDNEY AND URINARY TRACT

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  1. Disorders OF KIDNEY AND URINARY TRACT Dr. ShreedharPaudel 12 April, 2009

  2. Disorders OF KIDNEY AND URINARY TRACT • INTRODUCTION • REVIEW OF ANATOMY PHYSIOLOGY OF KIDNEY • APPROACH TO KIDNEY DISEASES • AGE AT EVALUATION: • NEONATE- MULTICYSTIC RENAL DYSPLASIA • < 3 YEARS – UTI, WILM’S TUMOR OR PCKD, HUS,RTA • 3-6 YRS- MCNS,GN • 6-14 YRS - AGN

  3. Disorders OF KIDNEY AND URINARY TRACT……….. • Clinical features :- • OLIGURIA- < 1ML/KG /HR • EDEMA • HEMATURIA • DYSURIA, FLANK PAIN, URETERIC COLIC • ENURESIS • HYPERTENSION • GROWTH RETARDDATION • ANEMIA • ABDOMINAL MASS • POLYURIA AND POLYDIPSIA

  4. Disorders OF KIDNEY AND URINARY TRACT……… • INVESTIGATION :- • URINE EXAMINATION • SERUM CREATINE, Sodium, Potassium • URINARY CONCENTRATION TEST • IMAGING OF URINARY TRACT

  5. NEPHROTIC SYNDROME • MASSIVE PROTEINURIA >1GM/M2/DAY • HYPOALBUMINEMIA < 2.5GM/DL • EDEMA • HYPERLIPIDEMIA

  6. NEPHROTIC SYNDROME • CAUSES:- 1. MINIMAL CHANGE NEPHROTIC SYNDROME 2. MESANGIAL PROLIFERATIVE GN 3. FOCAL SEGMENTAL GLOMERULO SCLEROSIS 4.MASSIVE PROLIFERATIVE GN 5. AMYLOIDOSIS,VASCULITIS, SLE, POSTINFECTIOUS, HEP B

  7. NEPHROTIC SYNDROME • Minimal change Nephrotic syndrome:- • 80-85 % cases of NS in children • Pathogenesis is unknown • 2-6 YRS • No hematuria • BP normal • Serum C3 normal • Selective proteinuria • Good Steroid responsive • Good prognosis

  8. NEPHROTIC SYNDROME… • Nephrotic Syndrome with significant lesion:- • Older children • Hematuria present • BP– normal or increased • GFR—normal or decreased • Renal biopsy—immunoglobulin deposits • Serum C3 decreased • No selective proteinuria • Response to steroid– not good • Significant proportion may progress to CRF

  9. NEPHROTIC SYNDROME • INVESTIGATION:- • URINE EXAMINATION • SERUM ALBUMIN • SERUM CHOLESTEROL • SERUM C3 • RENAL BIOPSY • RFT

  10. NEPHROTIC SYNDROME • MANAGEMENT:- • INITIAL EPISODE • PREDNISOLONE 2MG/KG/DAY- 6 WEEKS, • 1.5 MG/KG/ ALTERNATE DAYS FOR 6 WEEKS • FIRST 2-3 RELAPSE • PRED 2 MG/KG/DAY FOR 2 WEEKS • 1.5 FOR 4 WEKS

  11. MANAGEMENT…. • FREQUENT RELAPSE OR STEROID DEPENDENT • ALT DAY PRED O.3 -0.7 MG /KG FOR 9-12 MTHS • LEVAMISOLE • CYCLOPHOSPHAMIDE • CYCLOSPORIN

  12. NEPHROTIC SYNDROME • General measures:- • HIGH PROTEIN DIET • NO EXTRA SALT • TREATMENT OF THE INFECTION • TREATMENT OF STERIOD SIDE EFFECTS • DIURETICS IF EDEMA SEVERE

  13. NEPHROTIC SYNDROME…. • COMPLICATIONS:- 1. EDEMA 2. INFECTION 3. THROMBOTIC EPISODE 4. ARF 5. STEROID TOXICITY

  14. PROTEINURIA • Common Causes of Benign Proteinuria • Dehydration • Emotional stress • Fever • Heat injury • Inflammatory process • Intense activity • Most acute illnesses • QUANTIFICATION • MILD --MODERATE – 100-1000mg/sq.m/day • NEPHROTIC RANGE-- > 1000mg/ sq.m/day

  15. Proteinuria… • The dipstick is reported • as negative • trace (10–20 mg/dL) • 1+ (30 mg/dL) • 2+ (100 mg/dL) • 3+ (300 mg/dL) • 4+ (1000–2000 mg/dL).

  16. Proteinuria… • Glomerular:- • Increased glomerular capillary permeability to protein --Primary or secondary glomerulopathy • Tubular:- • Decreased tubular reabsorption of proteins in glomerular filtrate --Tubular or interstitial disease • Overflow:- • Increased production of low- molecular-weight proteins --Monoclonal gammopathy, leukemia

  17. Proteinuria… • Fatty casts, free fat or oval fat bodies • Nephrotic range proteinuria (>3.5 g per 24 hours) • Leukocytes, leukocyte casts with bacteria • Urinary tract infection • leukocyte casts without bacteria • Renal interstitial disease • Normal-shaped erythrocytes • Suggestive of lower urinary tract lesion

  18. Proteinuria….. • Dysmorphic erythrocytes • Suggestive of upper urinary tract lesion • Erythrocyte casts • Glomerular disease • Waxy, granular or cellular casts • Advanced chronic renal disease • Eosinophiluria • Suggestive of drug-induced acute interstitial nephritis • Hyaline casts • No renal disease; present with dehydration and with diuretic therapy

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