Akhtar Ali, Sultan Zafar, Shad Muhammad.
Community management of Nephrotic syndrome a lesson to be learnt.
Med Channel Jan ;13(2):36-41.

OBJECTIVE: To analyze pre-hospital treatment of Nephrotic patient, time of referral, adequacy of diagnosis, appropriateness of treatment and its impact on the morbidity of Nephrotic patients as managed in community. MATERIAL & METHOD: This prospective study was conducted in Department of Nephrology PGMI, LRH from January 2005 to December 2005(01 Year). RESULTS: 50 Nephrotic patient regardless of the age full filled the inclusion criteria. From 3 to 60 years of age, with mean age of 19.8 years. Male to female ratio 2.5-1 was included in the study. At presentation 76% were nephrotic, 22% were hypertensive with nephrotic syndrome and 1.6% with albumuria only. Mean duration of illness was 17.5 months before referral. 98% have received steroids before coming to hospital. 47% of the patients were managed by GPs 19.5% by physician 9.1% by pediatrician and 7.8% by Urology colleague. Mean urea before referral was 86.79mg% with a mean creatinine of 2.7mg%. 52% of patients had theirs abdominal ultrasounds before arrival. Hepatitis B&C screening was not done in 78%. Most common complication was severe nephrotic syndrome (56.4%), hypertension with renal insufficiency 16.79%, hypertension without renal insufficiency 14%, septicemia 6.5% and ARF 3.8%. Histological renal amyloidosis was the most common 20%, crescentic GN 17%, MCD 17%, mesangio cap 12%, FSGS 10%, IgA 7%, SLE 5% was found CONCLUSION: Nephrotic syndrome can be caused by a number of Etiological factors. Proteinuria is the end result of renal injury and not diagnosis it self. Proper diagnosis which is histological in many cases as in our study, timely referral and expert Nephrological help is the only way to reduce the morbidity and prevent progression of this treatable renal pathology.

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