DENTAL MANAGEMENT OF A PEDIATRIC PATIENT WITH NEPHROTIC SYNDROME- A REVIEW

Nephrotic syndrome is one of the chronic glomerular diseases in the pediatric population. It presents clinical symptoms and biochemical symptoms which results from proteinuria, hypoproteinemia, hyperlipoproteinemia and hypoalbuminemia. Here, we present the case of a 5-year-old male child who came with pain in his lower left and right back tooth region. He was diagnosed with nephrotic syndrome 4.5 years back and undergoing treatment and taking medications for the same. Extractions were done instead of pulp therapy to eliminate any dental sepsis including any teeth which were considered doubtful. All the extractions were performed under suitable antibiotic coverage and with the consultation of physician in charge. Our case report emphasizes on treatment which could reduce the morbidity and potential mortality associated with bacteremia which can be caused by any oral disease or dental procedures in child patients with nephrotic syndrome.

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Late Relapses of Membranous Nephropathy: A Case Series

Kidney360 ◽

10.34067/kid.0007712020 ◽

2021 ◽

pp. 10.34067/KID.0007712020

Author(s):

Yonatan Peleg ◽

Andrew S. Bomback ◽

Pietro A. Canetta ◽

Jai Radhakrishnan ◽

Gerald B. Appel ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Membranous Nephropathy ◽

Clinical Symptoms ◽

Case Series ◽

Renal Outcome ◽

Late Relapse ◽

Sustained Remission ◽

Glomerular Diseases ◽

Disease Remission

Background: Relapse of the nephrotic syndrome is common among primary membranous nephropathy (MN) patients. Relapses of MN typically occur within a few years of achieving disease remission. There is limited description to date regarding MN patients who have late relapse of MN, i.e. after more than five years of sustained disease remission. The objective of this case series was to report the clinical course of MN patients with late relapse. Methods: We analyzed the patient database of the Center for Glomerular Diseases at Columbia University to identify patients seen at our center who had relapse of biopsy-proven MN at least five years after achieving sustained disease remission. Results: We identified 16 patients with late MN relapse. The median time in sustained remission prior to relapse was 10.2 (range 7-29.0) years. Ten (62.5%) patients were diagnosed with late relapse based on laboratory monitoring alone without clinical symptoms of the nephrotic syndrome. Fourteen (87.5%) patients received immunosuppression during their initial presentation and late relapse. Patients had favorable long term renal outcomes over a median 21 (range 12-56) year follow-up period with 14 (87.5%) patients in remission at study conclusion and median decline in eGFR per year -0.63 (range -6.3 - 17.5) ml/min/1.73m2/year. Conclusions: This case series highlights a previously under-appreciated and likely rare outcome of MN, namely late relapse. Late relapse patients, having a longer time in sustained remission, may have a more favorable long-term renal outcome.

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Pierwotna małopłytkowość immunologiczna u dzieci

Nowa Pediatria ◽

10.25121/np.2018.22.4.122 ◽

2018 ◽

Vol 22 (4) ◽

Author(s):

Anna Dusza ◽

Michał Matysiak

Keyword(s):

Immune Thrombocytopenia ◽

Clinical Symptoms ◽

Pediatric Population ◽

Current Data ◽

Current Investigation ◽

Surgical Interventions ◽

Hematological Disorders ◽

Primary Immune Thrombocytopenia

In this article we present current investigation on primary immune thrombocytopenia in children. There are described pathomorphology, clinical symptoms, diagnosis and treatment. We also present current data from literature about genetic tests and latest data on treating options in children. Primary immune thrombocytopenia (ITP) is one of the most frequent hematological disorders in pediatric population. Although the majority of children have a self-limited and short duration of the disease. However, approximately 20-30% of those patients can develop chronic ITP, which can cause significant complications and higher mortality and reduced quality of life. Especially regarding to long-term immunosupression or surgical interventions, such like splenectomy and restrictions on daily activities to avoid trauma. Over the past decades a lot of informations has been reported about pathogenic features of ITP. Nowdays, we know that it is not only caused by increased platet destruction and decreased platet production, but also complex, multifactorial immune dysregulation, like loss of immune tolerance and generation of platelet autoantibodies. In this article we present current investigation on ITP including clinical symptoms, diagnosis, pathomorphology and latests options on treatment in children. We also present current data about genetic biomarker, such as Vanin-1 (VNN-1) which has been suggested as one of predictors of chronic disease and potentially can offer early prognosis estimation.

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RENAL HISTOLOGY DURING TREATMENT WITH OXAZOLIDINE-DIONES (TRIMETHADIONE, ETHADIONE, AND PARAMETHADIONE)

PEDIATRICS ◽

10.1542/peds.30.4.601 ◽

1962 ◽

Vol 30 (4) ◽

pp. 601-607

Author(s):

A. Bergstrand ◽

C. G. Bergstrand ◽

N. Engström ◽

K. M. Herrlin

Keyword(s):

Electron Microscopy ◽

Nephrotic Syndrome ◽

Renal Disease ◽

Renal Biopsy ◽

Clinical Symptoms ◽

Clinical Signs ◽

Present Knowledge ◽

Short Report ◽

Renal Histology ◽

Renal Changes

Seven patients with petit mal seizures treated with trimethadione, ethadione, or paramethadione for long periods were subjected to renal biopsy at the age of 14½ 16½ years. None of the patients had clinical signs of renal disease at the time of the biopsy, but three of them had previously shown transient hematuria or proteinuria. The renal histology was studied by conventional methods and by electron microscopy, the latter method only including the glomeruli. The changes found must with the present knowledge be regarded as physiological. A short report is given of a patient with phenylketonuria and epilepsy who developed a nephrotic syndrome during treatment with tridione. No definite pathologic renal changes were demonstrated at the when the clinical symptoms had disappeared.

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New Aspects of Pathogenesis and Treatment of Membranous Glomerulopathy After the MENTOR Study

EMJ Nephrology ◽

10.33590/emjnephrol/20-00052 ◽

2020 ◽

pp. 46-53

Author(s):

Maurizio Salvadori ◽

Aris Tsalouchos

Keyword(s):

Nephrotic Syndrome ◽

Adrenocorticotropic Hormone ◽

Glomerular Diseases ◽

The Past ◽

Superior Efficacy ◽

Novel Drugs ◽

Membranous Glomerulopathy ◽

Blocking Mechanisms ◽

Antigenic Epitopes

Membranous nephropathy (MN) is the major cause of nephrotic syndrome in adults, accounting for 20% of cases with an annual incidence of 1 per 100,000 population. In the past 10 years, the role of podocytes has been identified. Environmental triggers in genetically predisposed patients can activate podocytes to exhibit antigenic epitopes, including PLA2R, THBS1, and NELL1, which become targets of specific autoantibodies with subsequent complement activation. The discovery of these mechanisms has opened a new horizon in the treatment of MN, and novel drugs are available with more specific mechanisms of action. Rituximab, a monoclonal antibody directed against CD20 expressed on B lymphocytes, has been used in several trials and appears to induce remission of nephrotic syndrome in 60% of patients (GEMRITUX trial). The recently published results of the MENTOR trial documented the superior efficacy of rituximab in patients observed for up to 24 months. In MN, the concept of targeting disease control has introduced novel therapies with specific blocking mechanisms, such as belimumab; nonspecific blocking mechanisms, such as those against adrenocorticotropic hormone; and new therapeutic options, such as ofatumumab, bortezomib, and eculizumab, which have recognised the pathological processes involved in the glomerular diseases.

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Corticosteroid-responsive nephrotic syndrome in children with myelodysplastic syndromes

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0210323b ◽

2002 ◽

Vol 130 (9-10) ◽

pp. 323-328 ◽

Cited By ~ 1

Author(s):

Radovan Bogdanovic ◽

Milos Kuzmanovic ◽

Jasmina Markovic-Lipkovski ◽

Milos Ognjanovic ◽

Dragan Micic ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Myelodysplastic Syndromes ◽

Rapidly Progressive Glomerulonephritis ◽

Corticosteroid Treatment ◽

Refractory Anemia ◽

Al Amyloidosis ◽

Glomerular Diseases ◽

Medline Search ◽

Haematological Remission ◽

Repeated Infections

Several reports have documented various forms of glomerular diseases in adults with myelodysplastic syndromes (MDS), but similar reports in children are lacking. We describe two children with MDS-associated with steroid-responsive nephrotic syndrome (NS). Patient 1, who had MDS with myelofibrosis, presented also hepatosplenomegaly, pancytopenia, chronic hepatitis, moderate proteinuria, hypocomplementemia and elevated ANA titer. During initial prednisone treatment proteinuria markedly diminished and partial but transient haematological improvement occurred. Relapse subsequently occurred that was manifested by overt NS and pancytopenia. High doses of prednisolone led to remission of the renal disease but haematological remission did not occur. Persisting pancytopenia and repeated infections terminated in sepsis, two years after the onset of MDS. Patient 2, who had refractory anemia with clonal monosomy 19, manifested bowel disease, hepatospleno- megaly, anaemia and non-organic specific autoantibodies. Prednisone led to both clinical and haematological remission. Haematologic disease relapsed 12 months later, when nephrotic-range proteinuria, haematuria and mild azotaemia were also found. Corticosteroid treatment led to long-lasting renal and haematologic remission, maintained by a small dosage of prednisone. In both patients renal biopsy findings were consistent with those seen in idiopathic NS. A Medline search disclosed 16 cases of glomerulopathy in the course of MDS in adult patients. Clinical features included NS, usually accompanied by renal insufficiency with either acute, chronic, or rapidly progressive glomerulonephritis. On biopsy, membranous nephropathy, crescentic or mesangial proliferative glomerulonephritis and AL amyloidosis, were found. We conclude: (1) that glomerular disease may be present and should be searched for in patients with MDS; (2) that MDS can be added to the list of rare conditions associated with corticosteroid-responsive NS in children.

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Correlation between Clinical Symptoms of Coeliac Disease, Serum IgA Anti TTG and Biopsy in Pediatric Population of Northern India

Asian Journal of Clinical Pediatrics and Neonatology ◽

10.47009/ajcpn.2020.8.1.16 ◽

2020 ◽

Vol 8 (1) ◽

pp. 65-68

Author(s):

Sumit Jeena ◽

Jaswinder Kaur ◽

Nishant Wadhwa

Keyword(s):

Coeliac Disease ◽

Clinical Symptoms ◽

Tissue Transglutaminase ◽

Pediatric Population ◽

Clinical Manifestations ◽

North India ◽

P Value ◽

Serum Iga ◽

Significant Difference ◽

The Mean

Background: Celiac disease is basically an immune-mediated enteropathic condition produced by permanent sensitivity to gluten in genetically susceptible subjects. There is paucity of data in north India regarding clinical symptoms of coeliac disease, Serum IgA Anti TTG and Biopsy in pediatric population. The present study was conducted with the aim to determine the correlation between clinical symptoms of coeliac disease, Serum IgA Anti TTG and Biopsy in pediatric population of northern India.Materials and Methods: The present study was conducted in prospective including 73 pediatric patients at Department of Pediatric Gastroenterology, Institute of Child Health, Sir Gangaram Hospital, New Delhi, India. Esophagogastroduodenoendoscopy and serum anti Ig A tissue transglutaminase were performed. The characteristic scalloping of the folds were looked for in endoscopy followed by four duodenal biopsies performed from second part of duodenum and histological grading was performed as per modified marsh system. Patients with Serum IgA anti tTG>20 U/ml were confirmed to be at risk. Complete histological work up was done including hemoglobin, RBC indices and peripheral blood smear examination. The association of clinical manifestations with disease grade was also established with correlation coefficient. All the data thus obtained was arranged in a tabulated form and analyzed using SPSS software. Probability value of less than 0.05 was regarded as significant.Results: There were 4 males and 16 females with marsh grade 1 and 2 and mean age of 7.3±1.9 years. There were 5 males and 8 females with marsh grade 3a and mean age of 6.8±2.3 years. The mean weight of 18.11±3.89, height of 103.17±8.73 and BMI of 16.26±3.78 was observed amongst subjects with Marsh grade 1 and 2. The mean weight of 15.12±3.17, height of 99.28±9.19 and BMI of 15.02±3.20was observed amongst subjects with Marsh grade 3a. Diarrhoea was maximum amongst subjects with grade 3c and 4(70%) and minimum amongst Grade 1 and 2 (40%). There was a significant difference between the frequency of anemia amongst different grades as the p value was less than 0.05.Conclusion: The most common presenting signs and symptoms were diarrhea and abdominal pain. The study also concluded that the incidence of anemia increases with higher marsh grades.

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Dental Management of a Patient with a Left Temporal Brain Abscess: A Case Report

Dental Update ◽

10.12968/denu.2021.48.1.54 ◽

2021 ◽

Vol 48 (1) ◽

pp. 54-57

Author(s):

Aliya Hasan ◽

Martin Tisdall ◽

Kathryn Harley

Keyword(s):

Case Report ◽

Paediatric Patient ◽

Clinical Relevance ◽

Causative Factor ◽

Odontogenic Infection ◽

Oral Disease ◽

Dental Management ◽

Odontogenic Origin ◽

Cerebral Infection ◽

Abdominal Infections

Cerebral abscesses of odontogenic origin are uncommon. Cerebral abscesses are often caused by cardiac and pulmonary disease or infections such as skin or abdominal infections. However, there have been some reported incidences of cerebral abscesses caused by odontogenic infection. This paper aims to discuss a case report whereby an odontogenic infection was the most probable cause of a cerebral abscess in a paediatric patient. CPD/Clinical Relevance: To discuss the importance of oral disease as a potential causative factor for cerebral infection.

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Approach to the Patient with Glomerular Disease

10.2310/tywc.12019 ◽

2018 ◽

Author(s):

Richard J. Glassock ◽

An S De Vriese ◽

Fernando C. Fervenza

Keyword(s):

Nephrotic Syndrome ◽

Renal Biopsy ◽

Rapidly Progressive Glomerulonephritis ◽

Chronic Glomerulonephritis ◽

Glomerular Diseases ◽

Diagnosis And Prognosis ◽

Protein Excretion ◽

Clinical Syndromes ◽

Organ Systems ◽

Therapeutic Decision Making

Glomerular diseases of the kidneys are associated with a limited array of clinical syndromes, including asymptomatic hematuria and/or proteinuria, acute nephritis, nephrotic syndrome, rapidly progressive glomerulonephritis, and chronic glomerulonephritis. The specific diseases that underlie these syndromes are numerous and heterogeneous. Broadly, they may be divided into primary and secondary disorders depending on whether the kidneys are the sole organs affected or whether other organ systems are also involved in the disease processes. A systematic approach involving a careful history, physical examination, assessment of renal function, and urinalysis (composition and microscopy) and protein excretion, combined with biochemical and serologic testing, can provide important clues to diagnosis and prognosis. Renal biopsy is often required for a complete and accurate diagnosis as well as a prognosis and therapeutic decision making. This review contains 4 figures, 6 tables and 92 references Key words: glomerular filtration rate, glomerulonephritis, hematuria, nephrotic syndrome, proteinuria, renal biopsy, serum complement

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Double symmetrical aortic arch in a Czechoslovakian wolfdog – surgical treatment and health assessment four years after treatment: a case report

Veterinární Medicína ◽

10.17221/274/2015-vetmed ◽

2017 ◽

Vol 62 (No. 5) ◽

pp. 279-284 ◽

Cited By ~ 1

Author(s):

P. Skrzypczak ◽

A. Piatek ◽

J. Biezynski ◽

Z. Kielbowicz

Keyword(s):

Aortic Arch ◽

Normal Development ◽

Clinical Symptoms ◽

Good Condition ◽

Health Assessment ◽

Positive Outcome ◽

Surrounding Tissue ◽

Normal Position ◽

Vascular Structures ◽

Left And Right

The paper describes a double symmetrical aortic arch in a dog trapping the oesophagus. Thoracotomy was performed in the fourth inter-costal space under general, isoflurane-maintained, anaesthesia. Cutting of the arterial ligament failed to free the oesophagus. Dissection of further vascular structures revealed the left and right aortic arches to be of similar diameter. A vascular clamp was put on the left arch for 10 min, while the patient’s cardiovascular parameters were monitored. The lack of significant cardio-respiratory symptoms indicated the necessity of ligating and cutting the left aortic arch. Removal of additional tissue from the region of the cut on the left arch completely released the oesophagus which was continuously monitored by video-oesophagoscopy. The chest was closed according to a standard thoraco-surgical procedure. The cutting of the left aortic arch and the release of the surrounding tissue restored the normal position of the oesophagus. After surgery, the animal was returned to its owners in a very good condition. Control examination showed complete amelioration of clinical symptoms and subsequent normal development of the dog. Intra-operative clamping of the left aortic arch with simultaneous monitoring by oesophagoscopy ensured a positive outcome of the surgery of the intra-operatively diagnosed double aortic arch.

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Mapping of Extracorporeal Space by Vibrotactile Reaction Times: A Far-Left-Side Disadvantage

Perception ◽

10.1068/p160283 ◽

1987 ◽

Vol 16 (3) ◽

pp. 283-290 ◽

Cited By ~ 15

Author(s):

Jane M Pierson-Savage ◽

John L Bradshaw

Keyword(s):

Clinical Symptoms ◽

Reaction Times ◽

Normal Subjects ◽

The Other ◽

Covert Attention ◽

Left Part ◽

Left And Right

Vibrotactile reaction times in normal dextrals were measured for the two hands separately when either hand was located at each of seven possible positions: 90°, 45°, and 15° to the left and right of the chest midline, and at the midline itself (0°). Reaction times for the two hands did not differ and there was no Hand by Position interaction. At 90° left, reaction times were significantly slower than at any other position except 45° right. However, none of the other positions, including 45° right, differed from each other. Performance in this task, therefore, was relatively uniform from 90° right to 45° left, but markedly slower at 90° left. This far-left-side disadvantage may reflect a difficulty (for dextrals) in focussing covert attention in the far-left part of space for a block of trials. Since vibrotactile reaction times are sensitive to attentional factors in normal subjects, the paradigm should allow quantification of the clinical symptoms of the hemineglect syndrome; some preliminary observations of this syndrome with another vibrotactile design are reported.

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