Nephrotic Syndrome

[Guest]

Miss jasmin M.vora aged 13 years c/o puffiness of face with weight gain since last 2 years she dont have any other complaint No.h/o of oiguria ,Haematuria , headache she had been diagnosed as a case of Nephrotic syndrome her other findings are : TPRBP normal, Urine Albumin 4+ , 4-5 pus cells /hpf , 24 hour proteins – 3.5gm, ANA negative TSH Normal ,S.Creatinine 0.8mg % HB.10.6gm,Total WBC 8,100,HIV,HbsAg &HCV is Nonreactive USG abdomen Normal Kidneys Renal Biopsy Performed :

Microscopic description : Specimen consists of tiny fragment of renal tissue containing 17 glomeruli with associated tubules and vessels . All the glomeruli have fairly open capillary lumina lined by membrance of normal thickness, normal distribution of mesangial matrix and cells and unremarkable Bowmans capsules ,some of the capillary lumina are mildley dilated and filled with fresh RBCs. Tubules are moderately degenerated, interstitium and arteries are rather unremarkable.

Diagnostic summary This girl was aknown case of Nephrotic syndrome has minimal change lesion some of the dilated capilllaries filled with fresh RBCs are suggestive of possibility of veinous Thrombosis at some level

Immunoflorocent studies: Submitted tissue does not reveal any fluorescence on staining with anti human IgG, IgA, IgM,C1g, C, albumin and fibrinogen anti sera.
No immune complex deposits nephropathy.

Treatment She is on steroid ( Prednisolone 40 mg / day for first two months than 20mg /day for one monyh than 20mg every alternate day ,than since last 6 months she is on 10mg Prednisolone every alternate day and there are no symptoms but if the steroid with draws than the symptoms again recures and due to steroids now her weight is increasing and she is having repeated UTI

What can be done for this young lady please inform me at: drdongre@rediffmail.com

[Guest]

hello, i have a similar case to this young girl, am also on steriod treatment and there isnt much else you can do, i am seeing a very good specliaist but once u go off the steriod treatment it is only to heal the kidney and try to prevent a relapse but there is nothing the doctors can do, im sure she will be fine, u dont get kidney failure from mild nephrotic syndrome. You should consult ur specialist however.

[quote] Miss jasmin M. vora aged 13 years c/o puffiness of face with weight gain since last 2 years she dont have any other complaint No... [/quote]

[Guest]

It appears that the patient has steroid dependent MCD. You need to work with you r Nephrologist closely. Sometimes patients are treated with alternative immunosuppressive drugs in hopes of decreasing the amount of Steroids (steroid sparring):
Other immunosuppressive drugs that have been tried include:
Cytoxan
Chlorambucil
Cyclosporin
Cellcept
Levaimsole

The decision on when to try these additional drugs is diffuclt and needs to be determined jointly between the patioent and the NEphrologist
[quote] hello, i have a similar case to this young girl, am also on steriod treatment and there isnt much else you can do, i am seeing a very good specliaist but once u go off the steriod treatment it is only to heal the kidney and try to prevent a relapse but there is nothing the doctors can do, im sure she will be fine, u dont get kidney failure from mild nephrotic syndrome. You should consult ur specialist however... [/quote]