Disorders OF KIDNEY AND URINARY TRACT

Disorders OF KIDNEY AND URINARY TRACT Dr. ShreedharPaudel 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 • < 3 YEARS – UTI, WILM’S TUMOR OR PCKD, HUS,RTA • 3-6 YRS- MCNS,GN • 6-14 YRS - AGN

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

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

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

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

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

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

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

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

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

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

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

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

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).

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

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

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

Disorders OF KIDNEY AND URINARY TRACT