Link to this page

Your search term(s) "nephrotic syndrome" returned 60 results.

Page 1 2 3 4 5 6    Display All

Do Current Recommendations for Kidney Biopsy in Nephrotic Syndrome Need Modifications?. Pediatric Nephrology. 17(6): 404-408. June 2002.

The current recommendations of kidney biopsy in childhood idiopathic nephrotic syndrome (CINS) were put forward to minimize unnecessary kidney biopsies in patients with underlying minimal change disease (MCD). However, there remains a diversity of opinion about the criteria for biopsying children with idiopathic nephrotic syndrome. This study was conducted to prospectively study the usefulness of these guidelines in avoiding biopsies in MCD and to evaluate further modifications for minimizing biopsies in CINS. Of 400 consecutive CINS patients, 222 patients were subjected to kidney biopsy according to the current recommendations. The histopathology spectrum of these selectively biopsied children revealed focal segmental glomerulosclerosis (FSGS) in 39 percent, MCD in 34.2 percent, membranoproliferative glomerulonephritis (MPGN) in 16.2 percent, mesangioproliferative glomerulonephritis (MesPGN) in 7.6 percent, membranous nephropathy (MN) in 1.8 percent, and diffuse mesangial sclerosis (DMS) in 0.9 percent. The authors observed that despite the current recommendations and efforts to minimize biopsy, 34 percent of children had MCD on histopathology. The authors recommend that biopsies in children (age 1 to 16 years) should be restricted to a subgroup with two or more clinical and biochemical parameters and in steroid non-responders. In addition, the decision to administer cyclophosphamide should be based on steroid response patterns without requiring a prior routine biopsy. 2 figures. 3 tables. 22 references.

Full Record   Printer Friendly Version

Immunotactoid Glomerulopathy. JASN. Journal of the American Society of Nephrology. 13(5 ): 1390-1397. May 2002.

This article acquaints readers with immunotactoid glomerulopathy (ITG), a kidney disease characterized by deposits in the glomeruli. The authors discuss exclusion criteria for the diagnosis of ITG, current controversies regarding the classification of this disease as one entity or two, clinical manifestations and laboratory findings, pathology, pathogenesis (development), therapy, and prognosis. The clinical and pathologic expressions of ITG are almost always solely confined to the kidney, and at the present time, the patient with ITG is best served by considering ITG as a primary glomerular disease. The presentation of ITG is similar to the other primary diseases causing the nephrotic syndrome, and although it is unresponsive to current therapy and frequently progresses, renal transplantation is a viable option for the patient with ESRD. ITG is one of the many conditions that are appropriatly categorized as fibrillary glomerulopathies, but the diagnosis should only be applied after systemic diseases that may be associated with organized glomerular immune deposits have been excluded. Restricting the diagnosis of ITG to the primary form of the disease focuses research efforts by avoiding confusion with well-defined diseases that may have organized glomerular immune deposits as part of the pathologic process. Most importantly, this restriction would allow the development of lesion-specific information for this group of patients in the future. 4 figures. 5 tables. 42 references.

Full Record   Printer Friendly Version

Levamisole: Adjunctive Therapy in Steroid Dependent Minimal Change Nephrotic Children. Pediatric Nephrology. 17(5): 355-358 . May 2002.

In children with minimal change nephrotic syndrome (MCNS, a type of kidney disease), the steroid dependent group constitutes an especially difficult case for management. Patients in this group are prone to serious steroid side effects. In addition, alkylating agents commonly fail to maintain remission and expose patients to more side effects. Therapy with the immunostimulant drug levamisole may therefore be another option in the attempt to maintain remission with minimal side effects. This article reports on the authors' experience in treating 20 steroid dependent primary MCNS patients with levamisole. All patients were children, with an age range of 3 to 15 years; 16 were boys and 4 were girls. Remission was first induced by steroids, then levamisole was added in a dose of 2.5 milligrams per kilogram body weight on alternate days for 6 months. During this period, the authors attempted to withdraw steroids completely and maintain patients on levamisole alone. Patients were followed for the occurrence of relapse and side effects. In 11 of 20 children (55 percent), steroids were successfully stopped for more than 2 weeks. At the end of the 6 month treatment period (i.e., after 4 months of steroid discontinuation), 10 patients (50 percent) were maintaining remission on levamisole alone. At the end of 12 months (i.e., after 6 months of levamisole discontinuation), five patients (25 percent) were still in remission without any treatment for the previous 6 months. No significant side effects were reported during levamisole therapy. The authors conclude that levamisole therapy for 6 months is a safe and perhaps effective therapy in a subset of children with steroid dependent MCNS to enable an otherwise infeasible withdrawal of steroids. 1 figure. 2 tables. 20 references.

Full Record   Printer Friendly Version

Management of Steroid-Sensitive Nephrotic Syndrome and in Children with Type 1 Diabetes. Pediatric Nephrology. 17(5): 351-354 . May 2002.

This article reports the cases of four children with steroid-sensitive nephrotic syndrome (SSNS) coexisting with type 1 diabetes. This number is higher than expected according to the estimated prevalence rates for each disease separately. In three of the children, diabetes preceded nephrotic syndrome (NS) and in one child it developed almost simultaneously. None of the patients had hypertension (high blood pressure) or retinopathy (eye disease). Two had a renal (kidney) biopsy; in one it was compatible with minimal change histology (MCH) and the other had MCH and early diabetic nephropathy (kidney disease due to diabetes) changes. The authors also briefly report on 12 previously described cases with biopsy. In 11 of these 12 previously reported cases, the biopsy showed MCH. In none was treatment influenced by biopsy results. However, experience suggests that daily steroid taper allows easier glycemic control than alternate day steroids. The authors conclude that the indications for a kidney biopsy in nephrotic children with and without insulin dependent diabetes mellitus should be similar. 1 table. 19 references.

Full Record   Printer Friendly Version

New Insights into Diuretic Use in Patients with Chronic Renal Disease. JASN. Journal of the American Society of Nephrology. 13(3): 798-805. March 2002.

Patients with chronic renal (kidney) insufficiency (CRI) or the nephrotic syndrome (fluid accumulation, protein in the urine, low levels of protein in the blood, and susceptibility to infection) frequently manifest diuretic resistance. This review article highlights new findings concerning the pharmacodynamics (drug action), kinetics (drug disposition in the body), and rational clinical use of diuretics in patients with CRI and the nephrotic syndrome. Factors limiting diuretic responsiveness in patients with CRI may include a reduced basal level of fractional sodium reabsorption that places an upper limit on diuretic response, and enhanced sodium chloride reabsorption in downstream segments, combined with a reduced delivery of diuretic to the kidney. Diuretic responsiveness in patients with the nephrotic syndrome is limited by avid sodium reabsorption by the terminal nephron. Strategies to improve loop diuretic responsiveness include increasing diuretic dosage, concurrent use of a thiazide diuretic to inhibit downstream sodium chloride reabsorption and attempts to maximally reduce albumin excretion. Strategies to limit albumin excretion include the use of an ACE inhibitor or an angiotensin receptor blocker and appropriate limitation of protein intake. These measures are more logical, effective, and less expensive than infusion of albumin (protein) solutions. 1 figure. 3 tables. 48 references.

Full Record   Printer Friendly Version

Nutrition Care of Adult Pre-ESRD Patients. IN: Guidelines for Nutrition Care of Renal Patients. Chicago, IL: American Dietetic Association. 2002. pp. 5-18.

This chapter on the nutrition care of adult patients who have pre-end-stage renal disease (pre-ESRD) is from a book that offers renal dietitians guidelines for the effective and efficient nutrition care of patients with kidney disease and for evaluating outcomes of the medical nutrition therapy (MNT) provided. The chapter includes a summary, a process flowchart, expected outcomes of MNT, detailed intervention session descriptions, and a bibliography. This chapter is designed to help dietitians work with adult patients who have renal insufficiency, including the nephrotic syndrome. The bulk of the material is presented in table format; a patient care algorithm (flowchart) is included. 1 figure. 6 tables. 88 references.

Full Record   Printer Friendly Version

Secondary Resistance to Cyclosporin A in Children with Nephrotic Syndrome. Pediatric Nephrology. 17(10): 842-846. October 2002.

This article reports on a study that investigated the phenomenon of secondary resistance to cyclosporine A (CsA) in children with steroid dependent (SD) or steroid resistant (SR) nephrotic syndrome. Secondary resistance was defined as an initial response to CsA with relapse on withdrawal of therapy and absent or diminished response on reinstitution of the drug. The study included 32 children with nephrotic syndrome who were treated with CsA. Results showed that 22 of the children (15 of 15 SD and 7 of 17 SR) responded while ten demonstrated primary CsA resistance. Of these 22 responders, 20 relapsed when therapy was tapered or discontinued. Cyclosporin was reinstituted in 19 children. Ten responded, demonstrating CsA dependence and nine exhibited secondary CsA resistance. Focal segmental glomerular sclerosis (FSGS) was present in one patient with CsA dependence on the initial biopsy and in 2 of 6 patients on a subsequent biopsy. In comparison, 7 of 9 patients with secondary CsA resistance and 10 of 10 with primary CsA resistance had FSGS on the initial or subsequent biopsy. The authors conclude that the presence of FSGS appears to increase the risk of secondary CsA resistance, and some of these children rapidly progress to end stage renal disease (ESRD). 2 figures. 2 tables. 31 references.

Full Record   Printer Friendly Version

Steroid Responsiveness and Frequency of Relapse in Adult-Onset Minimal Change Nephrotic Syndrome. American Journal of Kidney Diseases. 39(3): 503-512. March 2002.

This article reports on a study undertaken to clarify factors influencing the response to corticosteroids and subsequent relapse in minimal change nephrotic syndrome. The study was a retrospective analysis of 62 Japanese adult patients. Five patients experienced remission spontaneously. Fifty-three patients entered complete remission, 3 patients entered partial remission, and 1 patient showed no response to corticosteroids. The 53 patients with complete remission were divided into two groups: 38 early responders who experience remission completely within 8 weeks after starting treatment and 15 late responders who experienced remission after 8 weeks. Blood urea nitrogen (BUN) and serum creatinine levels and protein selectivity index at presentation were significantly worse in pate than early responders. Thirty-three patients experienced a relapse; 13 patients experienced multiple relapses. The 53 patients with remission were divided into three groups: 16 patients who experienced relapse within 6 months after the initial response, 17 patients who experienced relapse after 6 months, and 20 patients who did not experience relapse. Mean age at onset was younger in early relapsers than late or nonrelapsers. The authors suggest that impaired renal function and poor selectivity of proteinuria, which might be related to interstitial edema (fluid accumulation), were factors influencing a slower response to corticosteroids. Younger patients had a greater incidence of relapse and were prone to experience relapse earlier. 3 figures. 5 tables. 26 references.

Full Record   Printer Friendly Version

Approach to the Patient with Renal Disease. In: Schena, F.P., ed. Nephrology. New York, NY: McGraw-Hill, Inc. 2001. p. 3-9.

This chapter is from a book on nephrology (the study of the kidney and kidney diseases) from the McGraw-Hill Clinical Medicine series dedicated to different medical specialties. The book is designed for general practitioners and family care providers and offers strategies for the management of patients with renal (kidney) damage. This introductory chapter summarizes the recommended approach to the patient with renal disease. Topics include syndrome analysis in patients with kidney disease; specific syndromes including hypertension, electrolyte disorders, urinary abnormalities, disorders of renal tubular function, acute renal failure, nephritic syndrome, and nephrotic syndrome; laboratory testing in this population; evaluation of renal function, notably with the glomerular filtration rate (GFR); the usefulness of evaluating glomerular filtration; quantifying GFR in patients with acute renal failure (ARF); establishing the presence or absence of renal insufficiency (determination of normal kidney function); quantifying progression in patients with chronic renal disease; assessing renal function in the elderly; and diagnosing uremia and timing the need for starting renal replacement therapy (dialysis or transplantation). Patient care algorithms are provided. 1 table. 5 figures. 15 references.

Full Record   Printer Friendly Version

Edema and Acute Renal Failure. Seminars in Nephrology. 21(3): 251-256. May 2001.

This article explores the occurrence of edema (fluid accumulation) associated with acute renal (kidney) failure (ARF). Edema occurs as the result of imbalance between net transcapillary fluid filtration and removal of tissue fluid by the lymphatic system. In normal conditions, edema does not occur, despite wide variations of systemic blood pressure (BP); the occurrence of edema depends on local and systemic factors. ARF with overhydration and edema may follow glomerulonephritis (inflammation of the kidney glomeruli and nephrons, or filtering bundles), because of reduction of the glomerular capillary area available for filtration. But ARF may also be observed in patients with edema who have minimal change nephrotic syndrome; this ARF may require dialysis until recovery and is attributable to the following factors: ischemic renal injury (injury due to lack of blood flow in the organ); hypovolemia (low blood volume); interstitial edema with tubular collapse; redistribution of renal blood flow; decrease of capillary filtration capacity; and use of nonsteroidal antiinflammatory drugs. Congestive heart failure also leads to prerenal azotemia (excessive amounts of nitrogen in the blood) and edema formation secondary to salt retention. Multiple organ dysfunction syndrome (MODS) is frequently associated with ARF; but edema occurs even without ARF in septic patients with severe inflammatory response syndrome (SIRS). ARF may follow severe burns; burned patients are frequently edematous because of a rapid leak of fluid from the vascular bed into the wound; edema in undamaged areas occurs because of a fall of oncotic pressure because of massive loss of plasma proteins into the wound. Edema must be treated with diuretics or by dialysis. 2 figures. 35 references.

Full Record   Printer Friendly Version

Page 1 2 3 4 5 6    Display All

Start a new search.