القائمة الرئيسية

الصفحات

Diabetic Nephrotic Syndrome (Steroid Resistance Nephrotic Syndrom)





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History was started at 4.3.2017
14 years old female
From Yurem in Yemen living in Sana'a
known case of D.M since age of 6 year on insulin
Had generalized swelling & anuria.
History Of Present Illness :
Fever
Vomiting & abdominal pain
Difficult of breathing
Mild headache
No picture of anemia
Decrease appetite & weight & activity
Sleep disturbance.
Past history :-
No similar attack (disease)
Patient has congenital rubella
Patient has PDA ligation , cataract surgery
Negative Blood Transfusion, allergy history
History of drug and hospitalization for D.M.
Family history:
Consanguinity 1st degree.
Grandfather has D.M. 
Healthy 70-year-old father
Hypertension mother
low Socioeconomic level.
Summery :
14 y female DM uncontrolled  Anasarca- anuria: For 10 days
Negative personal and family history
For DD: Heart failure  Liver failure  Renal disease
Hypo-protein-urea : burn- GIT loss- renal loss
Plan of management  Full history
Full examination  Routine investigation:-
CBC Test  Biochemical Test for RFT & cholesterol & Glucose Urine Test for protein
Effect D.M drugs on nephrotic syndrome :
As we know the patient has SRNS + un-controlled DM + using of cyclosporine drug + corticosteroid drug so our patient now into of these complication :-
Injury of glomerulo of the kidney
Neuropathy complication Ophthalmologic complication
Effect Nephrotic drugs on D.M :
As all of corticosteroid drug side effect + patient has un-controlled insulin that will causes :- Recurrent infection Hyperglycemia Recurrent NS symptoms Proteinuria Anasarca Hypertension
Effect of Chemotherapy drugs on nephrotic & DM :
Cyclosporine has a well-known spectrum of side effects such as :- Nephrotoxicity  Infection  Hypertension
hyperkalemia, renal  tubular acidosis  Tremor
glucose intolerance gum  hypertrophy Hirsutism
The therapeutic drug level (trough) of cyclosporine is <100-200 ng/mL. Our update was considering on multiple studies : older medications can be replaced with newer ones such as MMF, tacrolimus , and rituximab with good outcomes and better side effect profiles. Cyclosporine is lesser relapse of cyclosporine
Our update was taken from:- PubMed (Studies)
Korean Pediatric Society (Studies


Management In Emergency Room :
O2 inhalation
Dopamine 250mg in 50cc i.v infusion 2cc/h
Albumin 20% with Lasix 40mg i.v
IVF N/S and DNS according to RBS
Regular Insulin 50unit on 50cc N/S IV infusion 4ml/hrs with Change insulin IV to SC.
Ceftriaxone 1g i.v B.D
Ca gluconate 10% 10ml i.v in dex 5% 20cc slowly over 10 min B.D
Abd/USG
Decrease IVF 50ml/hrs
Prednisolon tab 20mg
Give regular insulin according sliding scale every 6hrs14×
Time of Discharge was on 13/1/2019 :-
The urine analysis test: no proteinuria (remission)
history of follow up:-
After multiple relapse she had given cyclosporine tab at 8.3.2017
Started by 25 mg/day then increased to 50 mg/day
Patient have Steroid-Resistant Pediatric Nephrotic Syndrome (SRNS)
With a history of congenital rubella:-
PDA Cataract DM
Our follow up in per a years show improvement and multiple relapse all most of months.
Creatinine was –ve in urine
S.albumine was nuill in 17.4/11.6/30.7/27.8/24.9/5.11/20.11.2017 and in 6.3/4.4/7.5/3.9.2018
S.albumine & creatinine & cholesterol & ca & cyclosporine in blood was within normal range.
Patient she using chemotherapy until today with corticosteroid.






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