Nephrotic syndrome related to Minimal Change Disease
Introduction
The case narrative that is being discussed is a patient with a PMH of chronic kidney disease (CKD) who presents to the hospital with acute kidney injury (AKI). Nephrology was consulted for evaluation and management. This case was interesting to me because of the unique cause of Nephrotic syndrome called Minimal Change Disease (MCD). MCD is a kidney disease in which large amounts of protein are lost in the urine the podcytes that are part of the glomerular filter become effaced (Up-to-date, 2017). MCD is a major cause of nephrotic syndrome in both children in and adults, in children it is often linked to a genetic defect (Up-to-date, 2017). However, in adults MCD occurs as an idiopathic or secondary condition cause by an overuse of non-steroidal anti-inflammatory drugs (NSAIDS) and selective COX-2 inhibitors (Up-to-date, 2017). It is important for primary care providers to be aware of this MCD, so that
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Educate on the use of NSAIDs with CKD
Illness progression and prognosis
Daily CMP, CBC
Evidence:
The exact pathogenesis underlying the cause of MCD is unclear. But researcher have evidence suggesting that systemic T cell dysfunction results in the production of a glomerular permeability factor. This circulating factor directly affects the glomerular capillary wall, resulting in marked proteinuria and foot process fusion (Up-to-date, 2017). MCD characterized by the following findings: elevated serum creatinine, 1.4 mg/dl, estimated glomerular filtration rate greater than 72 mL/min per 1.73 m2, proteinuria 9.9 g/day, hematuria, serum albumin 2.2 g/dL, serum cholesterol 421 mg/dL, hypertension, acute renal failure (Up-to-date, 2017).
Critical
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There are two types of glomerulonephritis—acute renal failure (ARF) and chronic kidney disease (CKD). The ACF form generally develops suddenly as a result of an infection or illness, such as, group A streptococci bacteria, hepatitis, or in diseases such as lupus or HIV (Mathias, 2013). This type may require dialysis to replace renal function while it lasts, however, kidney function usually returns after the primary illness is treated. Many acute patients will not have any other complications as no permanent damage is done. Whereas CKD is found in a person that has had glomerulonephritis for months to years in some cases and may be asymptomatic until the kidney has become irreversibly damaged. ARF can evolve to become chronic if the glomeruli do not respond to
Kidneys play an important role in the unary tract. They are located on each side of the spine, just below the ribcage. Each kidney is connected to the bladder by ureters. The kidneys have many functions, but the most common functions are to clean waste, control chemicals, and regulate fluid in the body which makes up the urine. Urine collects in the kidney before entering the ureters and as time passes more materials are added. When calcium and oxalate or phosphates are combined in the kidney tiny stones are formed called nephrolithiasis, commonly known as kidney stones. These stones can be very painful and “increases risks for diabetes, high blood pressure, and osteoporosis” (Goldfarb, 2009). About ten percent of all people will have kidney stones in their lifetime. Kidney stones are most frequently found in white men over the age of forty, relatives of kidney stone patients, and people who have formerly had kidney stones.
Darien is a patient who possibly displays comorbidity. His symptoms lead me to believe that he could possibly be diagnosed with obsessive-compulsive disorder and generalized anxiety disorder. Darien’s symptoms that point to OCD are that he has rituals he must complete and if he does not he becomes anxious and is unable to continue with his day. He is however aware that these rituals are not actually helping him but he cannot stop doing them. He also reports feeling anxious most of the day, especially if he cannot perform his rituals, and that he is becoming increasingly more anxious. He is also unable to keep himself from worrying and feeling anxious.
Mcgrogan, A., Franssen, C. F. and De Vries, C. S. 2011. The incidence of primary glomerulonephritis worldwide: a systematic review of the literature. Nephrology Dialysis Transplantation, 26 (2), pp. 414-430.
Canavan disease is a rare genetic disorder that causes progressive damage to the nerve cells in the brain. While not yet curable, many therapies and experimental treatments are available to help those affected. As time goes on scientists will only continue to find a cure for Canavan disease and hopefully in the near future they will find one.
Chronic Wasting Disease (CWD) is a fatal neuro-degenerative, transmissible spongiform encephalopathy (TSE) of the family Cervidae (Hamir, et.al., 2006). The family Cervidae includes mule deer, Odocolileus hemionus, white-tailed deer, Odocolileus virginianus, Rocky Mountain elk, Cervus elaphus nelsoni, and moose, Alces alces shirasi, among others (Sigurdon & Aguzzi, 2007). CWD is a prion disease, meaning it is a protein caused infection, that occurs naturally in the deer family (Song & Lawson, 2009). This protein is suspected to be an abnormal isoform (PrPSc) of the naturally occurring host prion protein (PrPC) (Blanchong, et. Al., 2009). Bovine spongiform encephalopathy (BSE), mad cow disease, is a similar prion effecting cattle as CWD affects Cervidae. Although, scientists are not sure of transmission route it is suspected that CWD is transmissible and infectious through direct contact with infected individuals or through environmental contamination (Song & Lawson, 2009). Tests have been performed showing susceptibility of altered mice to oral transmission, mimicking the suspected route of entry, and the incubation appears slower but lasts longer with oral infection (Trifilo, et.al., 2007). The approximate time from the initial infection to death is three years.
Nephrolithiasis or kidney stone formation is a common form of renal disease characterized by crystal deposition in the renal medulla as a result of urinary supersaturation (Worcester and Coe 2009). It is the second most common kidney condition, and kidney stones affect approximately 6-12% of the United States population with the most affected subpopulation being Caucasian males. Nephrolithiasis is considered a systemic disorder that is associated with chronic kidney disease, an increased risk of coronary artery disease, bone loss and fractures, and type 2 diabetes mellitus (Sakhaee et al. 2012).
Complications related to diabetes and nephropathy are said to account for 50% of new cases of end stage renal disease (...
This article is for people whose kidneys fail to work. This condition is called end-stage renal disease (ESRD).
Bone diseases most directly influence the ability to walk or to move any part of the body--hands, limbs, neck, and spine. They are related to joint disorders--ARTHRITIS, COLLAGEN DISEASE, DISLOCATION of joints, and RHEUMATISM. The medical specialty pertaining to bone disorders is ORTHOPEDICS. Fractures are the most common bone disorders. They can occur as the result of an accident or be secondary to metabolic diseases.
Hemodialysis and Peritoneal Dialysis To the majority of Americans, dialysis is a confusing process that they will hopefully never have to endure, but for hundreds of thousands of people, it is a daily fact of life. According to US News and World Report, “In the United States, almost 400,000 people undergo dialysis every year.” (Gordon, 2012, para. 4)
Paget’s disease persistent condition by the normal bone remodeling process. The regular bone has a balance that makes it lay down new bone and take up the old bone. We are suppose to have a normal calcium level in our blood with the bone remodeling. Paget’s disease is affected mostly in older bones of adults. Don’t get me wrong Paget’s disease can be found in children which is called juvenile Paget’s disease. Another name for Paget’s disease is osteitis deformans.
According to the results of the tests, the patient syndrome is caused by either of the two; minimal change and focal segmental glomerulosclerosis. The pathophysiologies of the disease are primary glomerular defect and circulating permeability factor and inhibitors. The primary glomerular defect of nephrotic syndrome leads to leakage of high molecular mass proteins that’s equivalent to the size of albumin of approximately 66 kD, with haemostatic proteins of a similar size also being excreted pathologically in the urine (Eddy AA and Symons JM, 2003). Due to these excretion; prominent loss of important coagulation regulatory proteins such as antithrombin and protein S.
Chronic Kidney Disease. Mayo Foundation for Medical Education and Research, 2014. Web. 20 May 2014.