Nephrotic syndrome is a disease characterized by the appearance of blood in the urine (hematuria), elevated blood pressure (high blood pressure) and an acute renal function failure that causes the child to urinate less, and retain fluid and swell (edema). All these alterations may appear together or not and to varying degrees.

Why does it occur?

The nephrotic syndrome occurs because the kidney becomes inflamed, specifically internal structures called glomeruli that act as a filter or strainer. This inflammation of the glomerulus (glomerulonephritis) usually occurs after an infection, such as angina or skin infection caused by a bacterium called streptococcus (acute post-streptococcal glomerulonephritis).

It is not a kidney infection but occurs as a result of inflammatory response after infection. Other times, the glomerulus is altered without a known cause (primary glomerulonephritis) or by diseases that affect other parts of the body, such as in systemic lupus erythematosus, or IgA nephropathy (immunoglobulin A).
Symptom

Common symptoms of nephrotic syndrome are:

• Blood in the urine (dark, tea-colored or cloudy urine)
• Decreased urine volume (little or no urine may be produced)
• Swelling of the face, orbits, legs, arms, hands, feet, abdomen or other areas
• High blood pressure

Other symptoms that may occur include:

• Blurred vision, usually because of a blood vessel in the retina of the eye that bursts
• Cough that contains mucus or foamy and pink material because of the accumulation of fluid in the lungs
• Trouble breathing, because of the accumulation of fluid in the lungs
• General malaise (indisposition), drowsiness, confusion, aches and pains, headache Symptoms of acute renal failure or prolonged (chronic) kidney disease may occur.

Other Symtoms

The way in which the nephrotic syndrome manifests is very variable because not all the symptoms always appear together and in the same way. Blood in the urine (hematuria), for example, may be visible to the naked eye, with red or brown urine appearing, such as in meat washing water (macroscopic hematuria) and other times it can only be seen by scanning the urine with a microscope ( microscopic hematuria). Characteristically, the child does not feel any pain.

The alteration of renal function may be more or less intense, the child may urinate somewhat less or almost nothing and the edema may be very obvious or subtle. Blood loss in the urine can be accompanied by proteinuria (loss of protein in the urine), which increases edema (swelling). They can appear on the eyelids, legs, ankles or be generalized and cause the weight to increase. Sometimes children complain of a headache (especially if they have high blood pressure) and are tired.

Diagnosis

The diagnosis is suspected by symptoms and exploration. To confirm this, a urine test must be performed in which hematuria with or without proteinuria and a blood test to assess renal function will be observed. Depending on the previous history and the clinical history, other tests will be requested to try to find the cause: pharyngeal or skin culture, immunological tests (antibodies involved in the alteration of the glomerulus). In highly selected cases, a renal biopsy (analysis of a kidney sample) is necessary to find out the cause and severity of the renal involvement.

Treatment

There is no specific treatment for nephrotic syndrome. The objective is to control the alterations that it produces until the disease remits spontaneously:

• It is recommended not to abuse salt. If there are edema and/or arterial hypertension, a salt-free diet must be performed and the fluid intake reduced.
• Sometimes treatment with diuretics (medicines to urinate more) is needed to get edema and hypertension to decrease.
• In the most severe forms that do not remit spontaneously, sometimes the use of corticosteroids and even other immunosuppressants are required (to control the immune response that is damaging the kidney) depending on the cause.

Expectations (prognosis)

The prognosis depends on the disease that is causing the nephritis. When the condition improves, fluid retention symptoms (such as edema and cough) and high blood pressure may disappear in 1 or 2 weeks. Urine tests take months to return to normal. Children tend to have a better prognosis than adults and usually recover completely. Only rarely do
they suffer complications or aggravate and progress to chronic glomerulonephritis and chronic kidney disease.

Adults do not recover as well or as fast as children. Although it is unusual for the disease to come back, in some adults acute nephrotic syndrome does return, and this group will have end-stage renal disease and may need dialysis or kidney transplantation.

Chronic Renal Failure Treatment in Delhi

It consists of the progressive and irreversible deterioration of renal function. When the glomerular filtration rate – blood filtering in the kidney – falls below 25 to 35%, urea and creatinine begin to increase, patients being relatively asymptomatic or presenting anaemia, high blood pressure, polyuria, and nocturia. When glomerular filtration falls below approximately 15%, signs of uremic syndrome begin to appear and require urgent chronic renal failure treatment in Delhi.

Causes

Diabetes mellitus: the most frequent cause of CRF in developed countries. Renal involvement occurs after 10 years of diabetes, although it manifests clinically at 20 years.

Hypertension: produces an overload of pressure in the entire vascular tree, to which the vessels respond by strengthening their muscular layer. In the kidney there is a thickening of the wall of the vessels with a decrease in their caliber, leading to renal ischemia, and, on the other hand, glomerular hypertension occurs that puts excessive work on the glomerulus.

Glomerulonephritis: they consist of a glomerular involvement accompanied by vascular and renal interstitial involvement in some cases. Clinically they usually manifest with proteinuria, hematuria and slow or rapid deterioration of renal function (from days to years).

Tubulointerstitial nephritis: processes that predominantly affect the interstitium – one of the kidney areas – with the destruction of tubules and vessels, which results in ischemia and renal atrophy.

Hereditary renal processes: represented almost entirely by polycystic kidney disease. It is a hereditary process that is transmitted in an autosomal dominant manner and is a defect in the formation of renal tubules, which degenerate into cysts that grow progressively and destroy the healthy renal parenchyma.

Symptoms

Electrolyte disorders: abnormalities occur in the levels of different electrolytes such as potassium and bicarbonate. These alterations occur in the advanced stages of renal failure. Other abnormalities such as hypocalcemia and hyperphosphatemia may appear when renal failure is moderate.

Cardiovascular manifestations: arterial hypertension, found in up to 80% of patients with end-stage chronic renal failure. The fundamental cause is hydrosaline retention, although a hyperreninemia situation is also involved.

Gastrointestinal disorders: anorexia, nausea, and vomiting. A characteristic sign is a uremic fever, an ammoniacal smell produced by nitrogen metabolites in saliva.

Haematological disorders: an early sign in the evolution of chronic renal failure is anaemia, largely caused by erythropoietin deficiency (hormone synthesized in the kidney that promotes the generation of red blood cells), although other factors such as gastric losses also influence, decreased half-life of red blood cells due to the same uremia, malnutrition or iron deficit.

Neurological disorders: the appearance of uremic encephalopathy is typical, which manifests itself as a cognitive disorder that ranges from difficulty concentrating to a deep coma. A polyneuropathy may also appear that is sensitive at first but that, if it advances, also becomes motor.

Osteomuscular disorders (renal osteodystrophy): it is manifested by bone pain, deformities (resorption of distal phalanges in fingers), fractures and growth retardation in children.

Dermatological alterations: the characteristic sign is the straw colour of the skin, produced by anaemia and the accumulation of urochromes. Itching (itching) is also very frequent and very annoying.

Hormonal alterations: in men it mainly causes impotence and oligospermia (decrease in sperm production). In women, it causes alterations in the menstrual cycle and often amenorrhea (lack of menstruation).

DIAGNOSIS AND CHRONIC RENAL FAILURE TREATMENT IN DELHI

The diagnosis of chronic renal failure is based on the clinical manifestations presented by the patient, as well as the alterations that can be seen in blood tests.

The ultrasound shows that the kidney has decreased in size and has an alteration in its usual structure.

Conservative Treatment

It is important to start the chronic renal failure treatment in Delhi early in order to avoid complications, anticipate long-term sequelae and slow the progression of the disease as much as possible (protecting residual renal function).

Dietary control:

• Restriction of the consumption of salt, proteins, and foods rich in phosphorus and potassium.

Drugs:

• Protectors of renal function: angiotensin-converting enzyme inhibitors.

Electrolytic Correctors:

• Chelants of phosphorus.
• Potassium chelators are used in very terminal phases of chronic renal failure.

Hormonal correctors:

• Vitamin D: helps control the increase in parathyroid hormone and promotes calcium absorption and bone mineralization.
• Erythropoietin: stimulates the production of red series cells.

Substitute Treatment

There are currently three treatments for chronic end-stage renal failure: hemodialysis, peritoneal dialysis, and kidney transplant in Delhi.

In hemodialysis, the elimination of toxins and excess liquid is done through an artificial filter. It requires an extracorporeal circuit with the need for vascular access (arteriovenous fistula or hemodialysis catheter). It consists of intermittent sessions (three a week) of variable duration (3 to 4 hours).

In peritoneal dialysis, the elimination of toxins and fluid occurs through the membrane of the peritoneum. It requires a complete peritoneal cavity in need of implantation of a peritoneal dialysis catheter to introduce dialysis fluid into the abdomen. It is continuous dialysis, requiring the replacement of peritoneal dialysis fluid three or four times a day.

Transplant :

The steps followed in performing a transplant are as follows:

• Donor corpse.
• Compatibility of blood and immune group.
• Receptor selection (age, time on dialysis, clinical situation).
• Receiver Preparation
• Surgery.
• Immediate postoperative control (ICU).
• Late postoperative control (plant).
• Follow up in consultation

Systemic Erythomatous Lupus is a chronic inflammatory disease of autoimmune origin, the symptoms of which may appear in various organs slowly and progressively (in months) or more rapidly (in weeks) and vary with phases of activity and remission.

Two main types of lupus are recognized: the cutaneous, which manifests only with patches of skin (usually reddish or erythematous and hence the name lupus erythematosus), especially in areas that are exposed to sunlight (face, ears, neck (“V Neckline) and arms) and the systemic, in which one or more internal organs are affected.

Because it is a disease of the immune system, which is responsible for antibody production and organization of inflammation mechanisms in all organs when a person has SLE they may have different types of symptoms and various body locations. Some symptoms are generally such as fever, weight loss, loss of appetite, weakness, and discouragement. Other, organ-specific such as joint pain, skin blemishes, pleural inflammation, hypertension, and / or kidney problems.

Who has lupus?

Lupus can occur in people of any age, race, and gender, but women are much more affected. It occurs mainly between 20 and 45 years, being a little more frequent in people of mixed race and Afro-descendants. In India, we do not have exact figures, but estimates indicate that there are about 65,000 people with lupus, most of them women. It is thus believed that one in 1,700 women in Brazil has the disease.

What causes lupus?

Although the cause of SEL is not known, it is known that genetic, hormonal and environmental factors play a part in its development. Therefore, people who are born with genetic susceptibility to develop the disease, at some point, after an interaction with environmental factors (solar radiation, viral infections or other microorganisms), have immunological changes.

The main one is the imbalance in the production of antibodies that react with proteins in the body itself and cause inflammation in various organs such as the skin, mucous membranes, pleura and lungs, joints, kidneys, etc.). Thus, we understand that the type of symptom that a person develops depends on the type of autoantibody that the person has and that how the development of each antibody relates to each person’s genetic characteristics,

What are the symptoms of the disease?

The symptoms of SEL are diverse and typically vary in intensity according to the phase of activity or remission of the disease. It is very common for the person to have general manifestations such as tiredness, discouragement, low fever (but rarely, maybe high), weight loss and loss of appetite.

Manifestations may occur due to inflammation in the skin, joints (joints), kidneys, nerves, brain and membranes covering the lung (pleura) and heart (pericardium). Other manifestations may occur due to decreased blood cells (red and white blood cells) due to antibodies against these cells. These symptoms may arise in isolation or together and may occur simultaneously or sequentially. Children, adolescents or even adults may have swollen ganglia,

The most frequent clinical manifestations are:

Skin lesions: occur in about 80% of cases, throughout the course of the disease. The most characteristic lesions are reddish patches on the cheekbones and back of the nose, called butterfly wing lesions (the distribution on the face resembles a butterfly) and leave no scar.

Discoid lesions, which also occur more frequently in areas exposed to light, are well delimited and can leave scars with atrophy and changes in skin color. Vasculitis (inflammation of small vessels) can also occur on the skin, causing painful red or wine spots on the fingertips or toes.

Another very characteristic manifestation in SEL is what is called photosensitivity, which is nothing more than the development of a disproportionate sensitivity to sunlight. In this case, With only a little exposure to light or sun, it may result in skin blemishes as well as general symptoms (tiredness) or fever. Hair loss is very common but typically occurs in the activity stages of the disease and in most people hair usually regrow with treatment.

Articular: Joint pain with or without joint swelling occurs at some point in over 90% of people with SEL and mainly involves the joints of the hands, wrists, knees, and feet, which tend to be quite painful and occur in a way that occurs. intermittent, with periods of improvement and worsening. Sometimes they also arise as tendonitis.

Inflammation of the membranes covering the lung and heart is relatively common and may be mild and asymptomatic, or manifest as chest pain. Characteristically in the case of lung, pain occurs when breathing and may also cause a dry cough and shortness of breath. In pericarditis, in addition to chest pain, there may be palpitations and shortness of breath.

Kidney inflammation (nephritis): is one of the most worrying and occurs in about 50% of people with SEL. At first, there may not be any symptoms, only changes in blood and/or urine tests. In the most severe forms, high blood pressure, swelling in the legs, urine becomes foamy and there may be a decrease in the amount of urine. When not treated promptly and properly the kidney fails (kidney failure) and the patient may need dialysis or kidney transplantation.

Neuropsychiatric disorders: These manifestations are less frequent, but may cause seizures, mood or behavior changes (depression), depression, and peripheral nerve and spinal cord changes.

Blood: Changes in blood cells are due to antibodies against these cells, causing their destruction. Thus, if antibodies against red blood cells (RBCs) will cause anemia, against white blood cells will cause decreased white cells (leukopenia or lymphopenia) and if against platelets will cause decreased platelets (thrombocytopenia).

Symptoms caused by changes in blood cells vary widely. Anemia can cause pale skin and mucous membranes and tiredness, and thrombocytopenia can cause increased menstrual bleeding, bruising and gum bleeding. Usually, the decrease in white blood cells is asymptomatic.

How is the diagnosis made?

The diagnosis is made by the best nephrologist in Delhi recognizing one or more of the above symptoms. At the same time, as some changes in blood and urine tests are very characteristic, they are also commonly used for the final definition of the diagnosis. Common blood and urine tests are useful not only for the diagnosis of the disease but are also very important in defining whether there is SLE activity.

Although there is no test that is exclusively for SEL (100% specific), the presence of the test called ANF (antinuclear factor or antibody), especially with high titers, in a person with signs and symptoms characteristic of SEL, allows the diagnosis with much assurance.

Other laboratory tests such as anti-Sm and anti-DNA antibodies are very specific but occur in only 40% to 50% of people with SEL. At the same time, some blood and/or urine tests may be ordered to assist not in diagnosing SEL but in identifying whether or not there are signs of disease activity.

Malignant hypertension is a disease where, in addition to high blood pressure, there is damage to specific organs (such as the kidneys). It is a situation that needs immediate care and expert judgment as there is a risk of serious organ damage such as kidneys and even death.

Malignant arterial hypertension is characterized by severe and abruptly severe blood pressure elevation (characterizing a hypertensive emergency) where there is damage to target organs (vital organs) such as the kidneys and retina with retinal haemorrhage and papilla edema (vision). It requires an immediate reduction in blood pressure in a hospital setting. It is an important cause of morbidity and mortality.

This is why it is very important that a person is known to have high blood pressure regularly follow up with a Cardiologist in Delhi and Nephrologist in Delhi and do not let you take the prescribed medications.

The suspicion of renovascular hypertension is based on suggestive clinical findings, such as treatment-refractory hypertension, appearing before 20 and after 50 years, or associated with renal insufficiency.

The main complementary tests for screening for renovascular hypertension are captopril radioisotopic renal scintigraphy, peripheral renin collection captopril test, renal artery Doppler and, more recently, magnetic resonance angiography. The diagnosis is confirmed only by arteriography. Recent studies have shown alterations in endothelial function, oxidative stress and sympathetic nervous system in renovascular hypertension, which may be involved in the cardiovascular complications of these patients.

The main goals of renovascular hypertension treatment are the effective control of arterial hypertension and the preservation of renal function. The three available therapeutic modalities include clinical treatment, angioplasty or stent implantation and surgical revascularization. The choice of treatment should be individualized based on age, aetiology of stenosis and the presence of associated diseases.

Malignant hypertension is a serious complication of hypertension, characterized by severe and acute elevation of blood pressure, rapidly progressive renal failure, severe retinopathy and heart failure, culminating in the patient’s death within a few months if not treated properly. Currently, better control of blood pressure with effective treatment and knowledge of new pathophysiological mechanisms have improved the survival of these patients.

Pyelonephritis is a potentially serious infectious inflammatory disease caused by bacteria. It affects the renal parenchyma, where the urine-producing functional structures are located, and the dilated portion of the kidney (or pelvis), roughly shaped like a funnel, whose function is to facilitate the flow of urine through the ureters. so that it is stored in the bladder and then eliminated through the urethra.

Pyelonephritis or Kidney Infection Treatment in Delhi

In the chronic form, the kidneys gradually lose their ability to function because of an underlying disease ( high blood pressure and type 2 diabetes, for example) or repeated or poorly cured acute infections that can lead to kidney failure.

CAUSES

The E.coli ( Escherichia coli ), gram-negative bacteria that normally inhabit the gut, is responsible for approximately 90% of cases of kidney infection. It enters the body through the urethra, reaches the bladder, rises through the ureters and settles in one or both kidneys, compromising its functioning. Proteus, Klebsiella, Enterobacter, and Pseudomonas are other infectious agents that may be associated with disease episodes.

Although less common, the cause of pyelonephritis may be an infection with gram-positive bacteria, including Staphylococcus aureus. Coming from infectious outbreaks in other organs, this microbe can spread into the bloodstream and infect the kidneys. It is called the hematogenous pathway of disease transmission, which can spread the bacteria throughout the body causing sepsis, a very serious infectious process known in the past as “widespread infection”.

RISK FACTORS

The urinary tract has defense mechanisms that prevent the proliferation of pathogenic germs. In addition, the access of microorganisms to the upper urinary tract is hampered by the continuous flow of urine, which pulls them out of the body, and by the presence of sphincters, a type of valve that closes after the urine passes outwards.

However, even then, there are some conditions that increase the risk of developing pyelonephritis. Are they:

• Female Anatomy – More than men, women are subject to developing urinary tract infections that can affect the kidneys. To do so, it influences the size of the female urethra (3 cm), which is much shorter than the male urethra (measures around 12 cm) and is located between the vagina  and anus, a position that favours the entry of microbes, especially during the sexual act;
• Urinary tract obstruction – kidney stones, pregnancy, anatomical malformations, prolonged use of urinary catheters, and benign prostate enlargement are conditions that, in addition to slowing down urine flow and complete emptying of the bladder, favour the proliferation of bacteria that may harbour in the kidneys;
• Weakened immune system – People with HIV, hepatitis, diabetes, or using immunosuppressive drugs may have decreased ability to react against infection;
• Vesicoureteral reflux – the return of small amounts of urine from the urinary bladder to the ureters and kidneys during urination due to the malfunction of valves in the urinary tract. Although this reflux is more frequent in childhood, it can occur in adulthood as well.
• Diabetes, neurogenic bladder,  polycystic kidneys, recurrent cystitis are diseases that act as important risk factors for urinary tract infections.

SIGNALS AND SYMPTOMS

The symptoms of pyelonephritis are similar in the acute and chronic forms of the disease. However, it is worth noting some differences. In acute illness, they soon appear. In the chronic, asymptomatic phases alternate with others in which the clinical manifestations appear only during the periods in which the infection is active. Because of this characteristic of the disease, chronic bacterial infection can cause irreversible kidney damage that progresses to severe renal failure.

In both cases, however, the most characteristic symptoms are fever, chills, sweating, nausea, vomiting, malaise; low back and pelvic pain in the abdomen and back; urgency and pain (dysuria) to urinate, sign of pus (pyuria) and blood (hematuria) in the urine, which becomes cloudy and has an unpleasant odor.

DIAGNOSIS

The diagnosis of pyelonephritis considers the set of symptoms, especially the occurrence of high fever, chills and low back pain, as well as the clinical examination of the patient. Laboratory tests, such as complete blood count, type I urine and antibiogram urine culture, are useful to confirm the presence of the infection, identify the infectious agent and guide the therapeutic approach.

Imaging tests – computed tomography, ultrasound, and magnetic resonance imaging – are reserved to identify structural or anatomical abnormalities in the urinary system that pose an increased risk of severe kidney disease.

It is always important to establish a differential diagnosis with diseases that may have symptoms similar to those of pyelonephritis. These include pelvic inflammatory disease, cholecystitis ( gallbladder inflammation ), appendicitis (vermiform appendix inflammation), and acute pancreatitis (inflammation of the pancreas ).

TREATMENT

Pyelonephritis has a cure. Kidney infection treatment in Delhi with broad-spectrum antibiotics should begin as soon as the possibility of kidney infection is raised. The goal is to prevent the infectious agent from causing permanent damage to these organs or spreading the infection throughout the body, leading to multiple organ failures.

Waiting for the result of the urine culture test to identify the type of bacteria and antibiogram to know which drug is most effective in fighting it can be risky, as both take longer to complete.

Despite the delay, however, they are fundamental tests for the treatment of recurrent infections or those resistant to the initially proposed treatment.

For pain relief when urinating (dysuria) it is ideal to use painkillers. Anti-inflammatories should only be used under medical guidance, as they may aggravate the renal condition.

In general, the standard pyelonephritis treatment in Delhi is oral antibiotics for at least seven days. Depending on the characteristics and severity of the infection, intravenous medication may be required for up to 21 days. Although symptoms usually disappear within a short time, it is essential to follow the prescribed scheme until the end to prevent the recurrence of infections or for bacteria to become resistant to the indicated antibiotics.

Severe kidney infections, especially in childhood and the elderly, may require hospitalization to administer intravenous medication. Patients with chronic pyelonephritis, which leads to progressive and irreversible loss of the kidney, depending on dialysis until a kidney transplant can be performed.

Surgical procedures are indicated when obstructions or structural abnormalities of the urinary system facilitate the installation of infectious processes.

RECOMMENDATIONS

• Drink plenty of fluids, preferably water. In addition to keeping the body well hydrated, fluids help eliminate infectious agents when the person urinates;
• Answer your urge to empty your bladder promptly. Urine stored in the bladder can become a hotbed of infection;
• Urinate shortly after sexual intercourse as a means of eliminating bacteria that may have penetrated the urethra;
• Proceed to local hygiene with water. If using toilet paper after urinating or bowel movement, wipe it back and forth to prevent bacteria from spreading through the urethra and bladder.
• Double your attention if you are pregnant. Natural changes in your body – changes in urine characteristics, accelerated growth of the uterus and consequent bladder compression – increase the predisposition to urinary tract infections;
• Do not self-medicate or discontinue medication without first hearing what your kidney specialist in Delhi has to say.

Glomerulonephritis is an inflammation of the glomerulus, a functional unit of the kidney formed by a tangle of capillaries, where blood filtration and urine formation occur, glomerulonephritis treatment in Delhi is proposed by a nephrologist in Delhi according to the severity of the disease.

Glomerulonephritis may be primary or secondary, acute or chronic. The primaries settle directly into the glomerulus and are usually caused by immunological changes resulting from infections by viruses or bacteria. According to the clinical signs they present, they are given specific names. The most common is IgA nephropathy, or Berger’s disease, which is characterized by the presence of blood in the urine, high blood pressure and, in some cases, leg edema.

The secondary ones do not originate primarily in the glomerulus but are associated with diseases such as high blood pressure, diabetes, lupus erythematosus, hepatitis B and C, HIV infection, or even some medications. The most frequent causes, however, are diabetes mellitus and systemic arterial hypertension.

The characteristics and evolution of the disease vary greatly. For example, IgA nephropathy may go into spontaneous remission and only requires that the patient be kept under observation. However, there are severe cases in which the evolution of kidney disease is rapid, aggressive, and patients with the disease should be referred for dialysis or kidney transplant in Delhi.

SYMPTOMS

Primary glomerulonephritis may be asymptomatic, which delays diagnosis and initiation of treatment. When they appear, symptoms vary greatly from patient to patient. These include high blood pressure (high blood pressure), eye and/or leg edema, weight gain due to fluid retention, blood loss (hematuria) and protein (proteinuria) in the urine, tiredness, feeling unwell, weakness and anemia.

In secondary glomerulonephritis, foamy urine (as a result of proteinuria) and edema are the most common symptoms.

DIAGNOSIS

Clinical evaluation and laboratory tests of urine and blood, including the measurement of urea and creatinine, are important for the diagnosis of possible glomerulonephritis. The diagnosis of certainty, however, depends on the outcome of renal biopsy that should only be performed when indispensable for conducting treatment.

GLOMERULONEPHRITIS TREATMENT IN DELHI

Glomerulonephritis treatment in Delhi is proposed by a nephrologist in Delhi according to the characteristics, severity, and causes of the disease and may require or dispense the use of medications. If there is no need to prescribe them, the recommendation is to decrease protein, salt, and fluid intake and to strictly control blood pressure.

However, medications are fundamental in the treatment of underlying diseases, especially for the control of diabetes and hypertension.

RECOMMENDATIONS

• Periodically monitor blood pressure levels and blood sugar levels. Hypertension and diabetes are major causes of secondary glomerulonephritis;
• Strictly follow the treatment of underlying diseases that may be the cause of glomerulonephritis;
• Avoid excessive salt intake and alcohol consumption;
• Give well-deserved attention to strep throat, a microorganism that can cause kidney damage.

What is hypothyroidism?

In short, it is the drop in thyroid hormone production – triiodothyronine (T3) and thyroxine (T4). It is the most common disorder of this gland, which is in the neck region and resembles a butterfly.

Their performance reverberates throughout the body, interfering with women’s heart rate, bowel rhythm, mood, and menstrual cycle. The release of thyroid substances is orchestrated from the pituitary gland, which is in the brain.

Although produced in a smaller amount, T3 is the compound that acts for real in the rhythm of the functioning of our organs. The larger volume T4 is much less powerful. During its journey through the body, it turns into T3 – this, yes, the agent of the organism’s main operations.

In hypothyroidism, there is a decrease in the amount of T3 and T4 that goes into the bloodstream. One cause of the malfunction is Hashimoto’s thyroiditis, an autoimmune disease in which the defense system itself creates antibodies to attack thyroid cells.

Hypothyroidism is often associated with slight weight gain (eminently by fluid accumulation) and difficulty in getting rid of extra pounds. But these are just the most visible consequences of the crisis.

In T3 and T4 deficits, the heart decreases blood pumping and may suffer from heart failure. The kidneys cannot filter the right red liquid. The bowel slows and the skin dries out. The eyes, in turn, are at serious risk for glaucoma.

Children are not free of thyroid at idle. Lack of hormones impairs growth and can lead to intellectual disability. Since in the first weeks of life it is difficult to see any sign of the problem, the famous test of the foot, up to 48 hours after delivery, is a great ally because it can detect malfunction of the neck gland. It is then possible to start Hypothyroidism Treatment in Delhi as soon as possible to rule out the risk of neurological damage.

The most frequent cause of low hormone production in children and adolescents is Hashimoto syndrome. It can appear at any age and is usually noted in younger people with low growth, delayed puberty, itching and hoarse voice.

Signs and Symptoms of Hypothyroidism

• Somnolence
• Slight weight gain
• Tiredness
• Changes in mood
• Memory loss
• Dry skin
• Constipation
• Weak nails
• Loss of hair
• Feet and hands cold
• Feeling of excessive cold
• Anemia
• Change in libido
• High cholesterol

Risk factors

• Women over 30
• Age over 60 years
• Genetic predisposition
• Menopause
• Diabetes
• Pregnancy
• Postpartum period
• Pollution
• Excessive iodine in the feed

Prevention

The most important factor for the formation of T3 and T4 hormones is adequate iodine intake. About 150 micrograms of the mineral are the perfect amount to protect the thyroid.

The compost is present in table salt, seafood, and fish. On the other hand, overuse of the salt shaker – a very common fact among Indians – impacts the gland and can trigger hypothyroidism.

For those already suffering from the effects of hormonal loss, the recommendation in food is to handle vegetables such as cabbage, turnips and collard greens. They contain a substance called thiocyanate, which can inhibit thyroid work. Soy is also suspected: legume isoflavone would alter the rate of thyroid production and disrupt iodine absorption. Talk to a kidney spec about this subject.

The diagnosis

Even in the absence of symptoms of hypothyroidism, it is important to tell the doctor if there are cases of the disease in close relatives. It is also worth reporting any surgery or radiotherapy performed in the neck region. All this information is valuable to flag a possible failure to supply T3 and T4 to the body.

On clinical examination, the best nephrologist in Delhi palpates the neck to see if there are any changes in the thyroid. However, to confirm that the gland is working slowly, a blood test is required. The test can measure the dosages of T3 and T4. If the pair is down there, hypothyroidism is suspected. It turns out that hormonal falls are not noticeable at the onset of the condition. The question is the measurement of TSH, the pituitary hormone. If it is too high, it is a sign of trouble.

The use of ultrasound may be indicated to continue the investigation. In hypothyroidism, the gland tends to be atrophied. If the nephrologist in Gurgaon suspects a tumor, a scan called scintigraphy may be prescribed.

With the exception of the foot test, which reports congenital hypothyroidism in the newborn, neck ultrasound and tests that calculate the hormones TSH, T3, and T4 do not need to be done frequently in younger subjects unless there is any symptom or history of thyroid disease in the family. Other than that, checkups should only be requested for individuals over 40, especially women, who usually have more illnesses there.

The treatment

When thyroid production is low, the solution is to replace it with a synthetic version of the hormone T4. In the body, it is converted to T3 to act on cells. To reproduce this optimal thyroid function, the drug needs to be taken every day and the dose will depend on the degree of imbalance in the gland. Fine-tuning is not easy – so you can’t use the medicine without a nephrologist in Delhi.

The tablet has to be taken in the morning, fasting, about half an hour before breakfast. It needs a more acidic pH in the stomach to be absorbed. If something is ingested, the acidity reduces and compromises the use of the drug.

In general, hypothyroidism treatment in Delhi should be done for life. This is not the case only in transient forms of hypothyroidism, such as those that usually manifest in some postpartum women or even those caused by a side effect of medications. In these rare cases, hormone replacement is not always necessary and thyroid functions tend to normalize over time or with the suspension of the imbalance remedy.

Renal calculi or stones in the kidney are formations of stones in the kidney or in the urinary tract, resulting in the accumulation of existing crystals in the urine. Its presence may go unnoticed, without symptoms, but it can also cause very severe pain that begins in the back and radiates into the abdomen toward the inguinal region. It is a pain that manifests itself in cramps, that is, with a peak of intense pain followed by some relief. In general, these attacks may be accompanied by nausea and vomiting and require medical and hospital care for kidney stone treatment in Delhi.

CAUSES

Among the causes of kidney stone, it is important to highlight:

• Insufficient volume of urine, or supersaturated urine of salts;
• Lots of calcium, phosphates, oxalates, cystine, or lack of citrate;
• Metabolic disorders of uric acid or parathyroid gland;
• Anatomical changes;
• Urinary tract obstruction.

DIAGNOSIS

In addition to clinical evidence (severe pain and signs of blood in the urine), kidney stones can be diagnosed by abdominal X-rays, ultrasound or excretory urography, a more specific urinary tract examination.

SYMPTOMS

The typical symptom of kidney stones through urine is renal colic, a sharp, unilateral, severe low back pain that radiates to the front of the abdomen. In a few cases, patients are asymptomatic or little pain felt during the passage of the calculation by urethers.

However, there are other symptoms that may be associated with kidney stones, such as:

• Vomiting and fever;
• Blood in the urine;
• Suspension or decreased urinary flow;
• More frequent need to urinate;
• Urinary tract infections.

KIDNEY STONE TREATMENT IN DELHI

Contrary to what was recommended in the past, excessive seizures should be avoided. Excess fluid can increase urine pressure in the kidney and consequently increase pain. Treatments can be of various types:

• Medicines may be indicated only by the nephrologist in Delhi taking into account the cause of stone formation. During seizures, the use of potent painkillers and anti-inflammatory drugs is indicated to relieve pain, which is extremely strong, almost unbearable;
• Lithotripsy, that is, the bombardment of the stones by shock waves aiming at the fragmentation of the stone, which makes their elimination by urine easier;
• Percutaneous or endoscopic surgery: through the endoscope and through small holes, the stone can be removed from the kidneys after fragmentation;
• Ureteroscopy: Endoscopically allows the removal of stones located in the ureter.

KIDNEY STONE PREVENTION AND TREATMENT RECOMMENDATIONS

• Drink lots of water regularly. Two to three liters a day. This is the most important measure to prevent kidney stones;
• Use a paper filter when you might be eliminating a calculation. Analysis of its composition may guide the physician in choosing the most appropriate treatment;
• The use of pain medication should be prescribed by the kidney specialist in Delhi. Some of them are inadvisable for people with stomach problems or for pregnant women;
• Control the intake of protein and calcium-rich foods if the calculations are formed by excess uric acid or calcium;
• Do not self-medicate or make your own diagnosis. Seek medical attention, especially if you have severe back or abdomen pain and signs of blood in the urine.

IgA nephropathy is chronic kidney disease. It progresses for 10 to 20 years and can cause end-stage renal disease. It is caused by deposits of the immunoglobulin A (IgA) protein in the filters (glomeruli) in the kidney. These glomeruli normally filter waste and excess water from the blood and send them to the bladder in the form of urine. However, IgA protein avoids this filtering process.

This can generate the following factor:

• Blood and protein in the urine (hematuria and proteinuria)
• Swelling of the hands and feet (edema)

It is the most common cause of inflammation in older adults. It is more common in Caucasian and Asian people. It is most often found in people in their teens at 30 years of age. The IgA protein is a normal part of the body’s immune system. It is not known what causes IgA deposits in the glomeruli. In more than 10% of affected families, it is hereditary. Some people who inherit the gene may not have any symptoms, but they can transmit it. Men are more affected than women.

IgA nephropathy is a silent disease that can go unnoticed for years. This can occur at any age, but more often the symptoms begin before the age of 40. The most common symptom is blood in the urine (hematuria). It takes many years to move on to the stage that causes problems. These include inflammation, recurrent infections of the upper respiratory tract or intestinal disease. People with IgA nephropathy may also have flank pain and low fever. Very rarely, blood pressure can be dangerously high.

Causes

IgA is a protein called an antibody that helps the body fight infections. IgA nephropathy occurs when too much of this protein is deposited in the kidneys. IgA accumulates inside the small blood vessels of the kidney. Structures in the kidney called glomeruli are inflamed and damaged.

The disorder may appear suddenly ( acute ) or worsen slowly over many years ( chronic glomerulonephritis ).

The risk factors include:

• A personal or family history of IgA nephropathy or purple Henoch Schoenlein, a form of vasculitis that affects many parts of the body
• Be white or Asian

IgA nephropathy can occur in people of all ages, but it most often affects men from adolescence to the late 30s.

Symptom

Symptoms may not appear for many years.

When symptoms occur, they may include:

• Urine with blood that begins during or shortly after a respiratory infection
• Repeated episodes of blood or dark urine
• Swelling of hands and feet
• Symptoms of chronic kidney disease

Tests and exams

IgA nephropathy is often discovered when a person with no other symptoms of kidney problems has one or more episodes of bloody or dark urine. No specific changes are observed during the physical exam. Occasionally, blood pressure may be high or there may be swelling in the body.

Exams include:

• Blood urea nitrogen (BUN) to measure renal activity
• Creatinine in the blood to measure renal activity
• Kidney biopsy to confirm the diagnosis
• Urine analysis
• Urine Immunoelectrophoresis

Treatment

The goal of treatment is to relieve symptoms and prevent or delay chronic renal failure.

Treatment may include:

• Angiotensin-converting enzyme (ACEI) inhibitors and angiotensin receptor blockers (BRA) to control high blood pressure and swelling (edema)
• Corticosteroids, other medications that inhibit the nervous system
• Fish oil
• Medications to lower cholesterol level

Salt and fluid consumption may be restricted to control swelling. In some cases, a diet with low to moderate protein intake may be recommended by a nephrologist in Delhi. Finally, many people should receive treatment for chronic kidney disease and may need dialysis. Expectations (prognosis) IgA nephropathy slowly worsens. In many cases, it does not at all. Your disorder is more likely to get worse if you have:

• Arterial hypertension
• Large amounts of protein in the urine
• Increase in BUN or creatinine levels

Diabetes is a chronic disease that occurs as a result of the body’s difficulty in properly using carbohydrates, which results in an increase in blood glucose. The cause is the lack of insulin production in the pancreas or failure in its use. It requires lifelong diabetes treatment in Delhi.

Types of Diabetes

Type 1.- When the pancreas of the person suffering from it does not produce the insulin that is needed. Type 1 Diabetes is more common in children and young adults although it can occur at any age. People with Diabetes 1 need to administer insulin to control blood glucose levels. Diabetes 1 represents 5-10% of the entire population with Diabetes.

Type 2.- When the insulin produced by the pancreas of the sick person is not effective and does not function. Type 2 Diabetes is more common in older people, particularly those who are overweight. Currently, as a result of a sedentary lifestyle and the increase in obesity of the population, it also occurs in younger people. Often, Diabetes 2 can be controlled with diet, weight loss and exercise and also with pills. Diabetes 2 represents 90-95% of the entire population with Diabetes.

What complications can Diabetes give?

When glucose circulates in the blood instead of being used as energy, its concentration increases, hyperglycemia. This entails short and medium-term complications that, if not prevented, can affect the majority of blood vessels in our body. The most significant long-term complications are at the level of small vessels such as those of the kidney (nephropathy) and retina (retinopathy) and large vessels, causing the so-called generalized vascular disease, which affects the heart, brain, and lower extremities. It also affects nerve conduction leading to the so-called diabetic neuropathy.

What symptoms guide us to the presence of Diabetes?

The onset of Type I Diabetes is often sudden and may include symptoms such as increased urinary frequency, abnormal thirst, extreme tiredness, irritability, weight loss, frequent infections. Diabetes 2 starts gradually and is generally not detected. Sometimes symptoms similar to those of type 1 diabetes may appear, but much more attenuated. Often the initial symptoms are not detected and the diagnosis of the disease is made late, years after the onset of the disease. At that time in half of the patients, complications are already present.

Who is at risk for diabetes?

Some people may be more predisposed to present the disease. The most relevant factors explained by a nephrologist in Delhi are:

• Diabetes family history
• Excess weight, particularly abdominal obesity
• Age over 45 years
• Sedentary life
• Diabetes during pregnancy
• Abnormalities in glucose tolerance

Which is the best diabetes treatment in Delhi?

Diet, exercise, drugs called oral antidiabetics and finally insulin.

Can you prevent the onset of diabetes or its complications?

Being overweight and sedentary life are modifiable factors that can clearly influence the onset of Diabetes in predisposed people. Therefore, there are two clear factors that can be prevented.

What can be done to prevent kidney disease?

Kidney disease caused by diabetes occurs in a third of the population with diabetes. The first specific fact that alterations in the kidney are occurring in the presence of a protein called albumin in small amounts in the urine. This alerts you to the possibility that the small blood vessels that feed the kidneys may suffer damage if we do not act. There are interventions and drugs that can prevent and reverse kidney damage in the early stages.

Diabetic kidney disease “Diabetic nephropathy”:

Kidney disease caused by Diabetes is called Diabetic Nephropathy. It is a chronic and progressive disease that develops in a third of people with diabetes. High blood glucose levels affect the small vessels throughout the body and also those that are part of the kidneys. When these small vessels or capillaries are damaged, they do not work properly affecting their function, and filtration Toxic products can then accumulate in the blood, while other necessary substances such as proteins are eliminated in the urine improperly. If this progresses, we can reach the complete loss of kidney function that stops its filtration process, warns a nephrologist in Delhi.

Risk factors for kidney disease in Diabetes:

• Tobacco
• High blood pressure
• Uncontrolled blood glucose figures
• Family history of kidney disease

Signs and symptoms of kidney disease in Diabetes:

Symptoms of kidney involvement may appear late when the organ is already severely damaged. It is important to know the early signs that can alert us to the onset of kidney damage:

• Proteins in the urine
• Hypertension
• Swelling of legs and cramps
• Impaired renal function
• Increased frequency and amount of urine
• Less need for insulin
• Nausea and vomiting
• Weakness, paleness, and anemia

Treatment of Kidney Disease:

In the early stages of kidney damage, hypertension can be treated, glucose control can be improved and specific drugs for diabetic kidney disease can be administered. If the renal damage progresses and the renal insufficiency progresses, we may need treatment with techniques to replace the function of our kidneys, such as dialysis and transplantation.