Nephrotic syndrome is disease of the kidneys where the filtering system made of functional units called the nephrons, gets damaged. This is the name given to the collection of findings which develop as a result of such a damage. When the filtering system gets damaged, the kidney tends to filter substances which it usually doesn’t, and filter less of substances which it usually does. All of these issues give rise to some characteristic findings, which include:

Large amounts of protein present in the urine which results from leakage of protein through the damaged nephrons which usually prevent protein leak. This is known as proteinuria in medical terms and is calculated according to your child’s age and body weight.
Low levels of protein in the blood, which results from the protein leaking out into the urine, and is called Hypoalbuminemia.
Edema or tissue swelling in all areas of the body, which is the result of reduced levels of protein in the blood. This swelling is especially evident around the eyes, in the face, and in the abdomen which is known as ascites. The swelling results because the protein in the blood actually acts like a sponge which helps to keep most of the fluid in the blood, and when there is a reduced amount of proteins in the blood, the water tends to leak out from the blood into the tissues, resulting in swelling.
Increased levels of cholesterol in the blood, which results from reduced levels of protein in the blood which is a signal for the body to increase its production of certain types of fat.
The symptoms and signs of nephrotic syndrome:
The signs and symptoms that children often present with include:

Malaise and fatigue
Abdominal pain and swelling
Frothy urine
Increased body weight and facial edema
Loss of appetite
Paleness of the nail bed
Dull hair
Development of intolerance to certain food or allergies
The cartilage of the ears may feel less firm
The different types of nephrotic syndrome:
There are different types of nephrotic syndromes in existence as a result of the different causes. Some of these causes include, diabetes, hepatitis B and C, medications such as corticosteroids, and conditions like systemic lupus erythematosis, and cancer of the kidneys. The most common type of nephrotic syndrome to affect children is one that is known as idiopathic nephrotic syndrome, where there is no identifiable underlying cause.

Nephrotic syndrome can also be categorized according to the way the kidney tissue appears when it is viewed under a microscope following a biopsy. According to this tow forms have been recognized, Minimal Change Disease (MCD) and Focal Glomerular Sclerosis (FSGS).

Minimal Change Disease (MSD):
This is most common form to affect children and you will see that the renal cells look almost normal when seen under the microscope. It responds well to steroids, and has a good outcome in most cases. This form doesn’t have any lasting damage on kidney function, and relapses less and less frequently as the child ages, and is usually absent in adulthood. It is very rare for a child affected by minimal change disease to require dialysis or kidney transplant.

Focal Glomerular Sclerosis (FSGS):
This form of disease is present only in about 10% of the children with nephrotic syndrome. It requires biopsies in order to be diagnosed and doesn’t usually respond to steroid therapy, and is an aggressive form, which more often than not requires the child to undergo dialysis or a kidney transplant.

What is congenital nephrotic syndrome?
As the word suggests this form of nephrotic syndrome is present at birth, but it is most likely that the condition will go unnoticed at the time of birth and be discovered only when the baby is few months old. It is a very rare condition and is caused by a genetic predisposition where both parents have to be carriers of the condition. It is a very aggressive and severe form of nephrotic syndrome where the affected baby will require a kidney transplant as soon as possible, ideally within the first few years of life. And till a transplant becomes possible, the baby will require transfusions of blood protein almost every day, because the protein leaks out from the kidneys at a rapid rate. They will also require frequent boosting of their immune system and hormones in order to keep them healthy till the transplant can be done, and till they reach the appropriate weight with which a transplant becomes possible, which is about 15 pounds when the child is roughly around one year.

For more information = http://www.pediatricnephrologyindia.com/

Corneal Arcus
Corneal Arcus or Arcus senilis appears as a white, gray, or blue ring or arc around the cornea of the eye. The condition is usually seen in older adults but can affect people of all ages, even appearing at birth. Arcus senilis is generally harmless, and an involutional change modified by genetic factors. However, arcus is sometimes indicative of hyperlipidoproteinemia (involving low-density lipoproteins) with elevated serum cholesterol, especially in patients under 40 years of the age.

Causes of corneal arcus
Arcus is a deposition of lipid in the peripheral corneal stroma. Cholesterol and triglycerides are two types of fats in your blood. Some of the lipids in your blood come from foods you eat, such as meat and dairy products. Your liver produces the rest. Lipid deposition starts at the inferior and superior poles of the cornea and in the late stages encircle the entire circumstances. Arcus senilis is more common in men than in women. In people under age 40, arcus senilis is often due to an inherited condition and in rare cases, children are born with arcus senilis ( arcus juvenilis).

Arcus senilis can also appear in people with Schnyder central crystalline dystrophy. This rare, inherited condition causes cholesterol crystals to deposit on the cornea.

Symptoms
A person with arcus senilis may develop:

A white, gray, or blue circle around the cornea of the eye.
The circle or arc will have a sharp outer border but a blurred inner border.
If someone has an arc, the lines could grow to form a complete circle in front of the iris.
The presence of corneal arcus in patients younger than 40 year-old warrants evaluation for systemic lipid abnormalities.
Unilateral arcus is a rare condition associated with contra lateral artery disease or ocular hypotony. Usually it is an asymptomatic condition and does not affect your vision.

Diagnosis
Eye examination performed by eye doctor can diagnose arcus senilis. A slit lamp microscope is a very helpful tool to evaluate eye thoroughly. A special eye drop is used to widen the pupil of the patient. Once the eye drops works, ophthalmologist can inspect all parts of the eye with back of the eye as well for any disease. In arcus, thickness of the vessels increases due to fat deposition. Surgeon has to look for signs of atherosclerosis also, which is a condition where arteries become clogged with fatty substances.

A blood test will determine whether someone has high cholesterol. If they do, they may be prescribed medicine or advised on a suitable diet and exercise program to lower the cholesterol in their blood.

How corneal arcus is managed?
The good news is, you don’t need to treat arcus senilis. It typically affects both eyes, but in some cases only one eye has a grayish arc around the cornea, which may be a sign of poor blood circulation.

Eating healthy foods and exercising regularly are some good ways to keep your eyes healthy. We recommend wearing sunglasses with 100% UV protection when outdoors and safety goggles when doing hazardous tasks as well.

If arcus senilis is a sign of high cholesterol, a doctor may recommend a diet that is low in saturated fats and high in fruit, vegetables, and fiber.

If lipid levels are not controlled by diet and exercise are not enough, several medications can help lower your lipid levels:

Statin drugs block a substance your liver uses to make cholesterol. These drugs include atorvastatin, fluvastatin, pravastatin and rosuvastatin.
Bile acid binding resins force your liver to use more cholesterol to produce digestive substances called bile acids. This leaves less cholesterol in your blood. These drugs include cholestyramine, colesevelam and colestipol.
Cholesterol absorption inhibitors like ezetimibe reduce your body’s absorption of cholesterol.
Drugs may be used to lower triglyceride levels:
Fibrates reduce production of lipids in your liver and increase the removal of triglycerides from your blood.
Niacin reduces the production of lipids by your liver.
Increased exercise and quitting smoking can also help.
Possible complications
Arcus senilis alone is not known to have any complications unless it is a sign of high cholesterol. High levels of cholesterol in a person’s blood can cause significant problems, such as coronary artery disease or cardiovascular disease.

Follow-Up
Arcus senilis may sometimes appear as a white ring around the iris due to calcium deposits on the circumference of the cornea, where the white section of your eye (the sclera) and the colored part (the iris) meet (called the limbus). When the deposits consist of calcium, the limbus appears milky and may indicate tissue damage that needs correction.

The blue (or sometimes gray) ring around the iris often is associated with high cholesterol and triglycerides. In turn, this may be an indicator of heart condition that yor are more prone to heart attacks and strokes. When this condition appears in people younger than 60 years old, regular blood tests are normally recommended to monitor elevated lipid levels.

In few other cases, when corneas become opaque, due to genetic mutation it could be from a lowered high-density lipoprotein (HDL) cholesterol level. This condition can result in other eye problems. Principally, this opacification may be related to deficient levels of lecithin cholesterol acyl transferase (LCAT). LCAT is an enzymatic protein responsible for converting free cholesterol into cholesteryl ester.

Cholesterol ester, is then separated into the nucleus of the lipoproteins to produce a synthetic high-density lipoprotein (HDL) chain. This reaction is forced one way, since the deposits are removed from the exterior. So the enzyme is attached to both HDLs and low-density lipoproteins (LDLs) in blood plasma.

This process can result in the manifestation of fish eyes, and it is actually called “fish eye disease.� Corneal opacification can also result from mutations in another HDL protein, the adenosine triphosphate-binding protein ABCA1.

Just because you are younger than 40 and have arcus does not mean you absolutely have elevated lipid levels, but at a very minimum, it is recommended that you have them checked.

Unilateral corneal arcus may be associated with vascular or inflammatory etiologies.

Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult eye doctor about your specific condition. Only a trained, experienced board certified eye doctor can determine an accurate diagnosis and proper treatment.

To schedule an appointment with our experts for Corneal Arcus Treatment In Ghatkopar, please call us at +91 8451045935, +91-8451045934 or visit our clinic at Address.


For more information = https://www.mumbaieyecare.com/

Cerebral Venous Sinus Thrombosis In Pediatric Nephrotic Syndrome



A 2-year-old girl presented to the emergency room with recurrent seizures. The child had been diagnosed with nephrotic syndrome in the previous 2 weeks (serum albumin, 1.5 g/dl; serum creatinine, 0.4 mg/dl) and had been convulsing on and off since the week before presentation. Oral prednisolone (2 mg/kg per day) had been started for 2 weeks with no response. There was no metabolic cause of seizures with normal serum ammonia, blood gas, and serum electrolyte levels.
About Dr.

Dr. Sidharth Kumar Sethi
Kidney & Urology Institute
He was trained as a Fellow (International Pediatric Nephrology Association Fellowship) and Senior Resident in Pediatric Nephrology at All India Institute of Medical Sciences and Division of Pediatric Nephrology and Transplant Immunology, Cedars Sinai Medical Centre, Los Angeles, California. He has been actively involved in the care of children with all kinds of complex renal disorders, including nephrotic syndrome, tubular disorders, urinary tract infections, hypertension, chronic kidney disease, and renal transplantation. He has been a part of 8-member writing committee for the guidelines of Steroid Sensitive Nephrotic Syndrome and Expert committee involved in the formulation of guidelines of Pediatric Renal Disorders including Steroid Resistant Nephrotic Syndrome and urinary tract infections. He has more than 30 indexed publications in Pediatric Nephrology and chapters in reputed textbooks including Essential Pediatrics (Editors O.P. Ghai) and “Pediatric Nephrology� (Editors A Bagga, RN Srivastava). He is a part of Editorial Board of “World Journal of Nephrology� and “eAJKD- Web version of American Journal of Kidney Diseases�. He is a reviewer for Pediatric Nephrology related content for various Pediatric and Nephrology journals.


For more information = http://www.pediatricnephrologyindia.com/

Our Team Published A Very Important Review On ‘Multisystem Inflammatory Syndrome In Children
Our team published a very important review on ‘Multisystem Inflammatory Syndrome in Children with COVID- A Pediatric Nephrologist’s Perspective’ in journal ‘Clinical Kidney Journal’. This review is very important for all physicians, Pediatricians and Nephrologists taking care of children with COVID and AKI.

About Dr.
Dr. Sidharth Kumar Sethi
Kidney & Urology Institute
He was trained as a Fellow (International Pediatric Nephrology Association Fellowship) and Senior Resident in Pediatric Nephrology at All India Institute of Medical Sciences and Division of Pediatric Nephrology and Transplant Immunology, Cedars Sinai Medical Centre, Los Angeles, California. He has been actively involved in the care of children with all kinds of complex renal disorders, including nephrotic syndrome, tubular disorders, urinary tract infections, hypertension, chronic kidney disease, and renal transplantation. He has been a part of 8-member writing committee for the guidelines of Steroid Sensitive Nephrotic Syndrome and Expert committee involved in the formulation of guidelines of Pediatric Renal Disorders including Steroid Resistant Nephrotic Syndrome and urinary tract infections. He has more than 30 indexed publications in Pediatric Nephrology and chapters in reputed textbooks including Essential Pediatrics (Editors O.P. Ghai) and “Pediatric Nephrology� (Editors A Bagga, RN Srivastava). He is a part of Editorial Board of “World Journal of Nephrology� and “eAJKD- Web version of American Journal of Kidney Diseases�. He is a reviewer for Pediatric Nephrology related content for various Pediatric and Nephrology journals.

For more information = http://www.pediatricnephrologyindia.com/

CASE REPORT OF NOCTURNAL ENURESIS
ABSTRACT: Nocturnal enuresis (NE) is involuntary urination that occurs at night during sleep without any inherent suggestion of frequency of bedwetting or pathophysiology. There are a number of treatment options available for NE; such as drug therapy, bladder training, positive reinforcement, and the enuresis night alarm. It requires patience, persistence and motivation. Several behavioural approaches can be used for treatment such as enuresis night alarm therapy and various skills oriented components. A thorough homoeopathic case taking and treating with an individualised homoeopathic remedy of single dose gives an assured result. Case with marked peculiar symptom can be made basis of prescription and not all cases requires repertorization.
Keywords: Nocturnal enuresis, bedwetting, enuresis, homoeopathy, single dose, peculiar symptom.
INTRODUCTION:
Nocturnal enuresis (NE) is defined as “involuntary voiding of urine that occurs while sleeping that can happen at an inappropriate and socially unacceptable time and place� and due to which its negative impact occurs on the quality of life of the affected children and their families. It is most common in boys, with a ratio of three boys for every girl until the age of 15. Enuresis should be differentiated from continuous or intermittent incontinence or dribbling. The bed is usually soaking wet in enuresis, compared to incontinence in which there is loss of urine without normal emptying of the bladder.
More than 85% children attain complete diurnal and nocturnal control of the bladder by five years of age. The remaining 15% gain continence at approximately 15% per year, such that by adolescence only 0.5-1 % children have enuresis. Up to the eleventh year, enuresis is twice as common in boys as it is in girls; thereafter, the incidence is similar or slightly higher in girls.
Enuresis is called primary when the child has never been dry and secondary when bed wetting starts after a minimum period of six months of dryness at night.
Enuresis may be comorbid with mood and emotional disorders and also has a high level of comorbidity with attention deficit hyperactivity disorder (ADHD). Part of emotional disorder such as anxiety, expression and insomnia are experienced by persons who have elimination disorders related to distress and social stigma
Classifications
Enuresis classified on the basis of the time of occurrence into the following three subtypes:
• Nocturnal Enuresis: Passing urine during sleep.
• Diurnal Enuresis: Leakage of urine during waking hours.
• Monosymptomatic or uncomplicated NE: Normal voiding at night with absence of symptoms.
• Polysymptomatic or complicated NE: Bedwetting at day time with symptoms urgency, frequency, constipation and encopresis.
• Nocturnal and diurnal Enuresis, also known as nonmono-symptomatic enuresis.
Aetiology:
- NE is hereditary, children whose parents were not enuretic have only a 15% incidence of bedwetting and when one or both parent were enuretics, the rates increases to 44% and 77% respectively
- From the difficulty in waking up when the bladder is filled.
- excessive nocturnal urine production and nocturnal bladder hyperactivity
- Can be drinking late in the evening or not passing urine before going to sleep, resulting in excessive urine volume.
- Another cause may be a low amount of antidiuretic hormone during the night which controls the production of urine.
Goals of treatment
The following are goals of management for NE
• To stay without bedwetting on particular occasions such as sleepover at night or day.
• To decrease the frequency of wet nights.
• To decrease the impact of enuresis on the child and family.
• To avoid recurrence of bedwetting.
For achieving the above goals lifestyle and behavioural changes play an important role.

Primary management of enuresis is behavioural modification and positive reinforcement and it should be start with educating the child as well as parents about the condition, which can be achieved through :
-Behavioural Management.
-Night urine alarm therapy.
-Pajama (Under wear) Device
-Mechanism of action of Night urine Alarm Device
-Waking schedule

CASE REPORT :
A female patient of age 10 years visited our A. M. Shaikh Homoeopathic Hospital on 22/07/2019 with her father who described her case in detail with the presenting complaint of Bed wetting since 5 years.

History of presenting complaint
Patient came with the complaint of bed wetting at night and daytime as well; there is no single dry night since 5 years.At times she passes urine 2-3 times at night and once during her day/evening sleep.
No H/O Night terrors or Nightmare.
Treatment history:
Has consulted an allopathic paediatrician for the above mentioned complaint and was on treatment for 3years with no desirable improvement, so wilfully seeking homoeopathic treatment.
Past history: No H/O any major illness or any remarkable events occurred since birth.
Family history: Nothing significant. No family history of enuresis.
Milestones:
Neck holding - 4th month
Monosyllable speech – 7th month
Crawling – 9th month.
Sitting without support by 10th month.
Walking without support – 14th month.
Normal speech with meaningful words – after18 months.
Personal History:
Diet : Vegetarian,
Appetite :Not adequate, hardly eats a roti at times.
Thirst : 1 – 1.5 ltrs / day,
Micturition : D/N : 3-4/2-3,
Stools : Once/day, Regular, Soft.
Desires : Spicy food.
Life Space Investigation :
ï‚— Birth history : Full term normal hospital delivery. Mother had absolutely healthy pregnancy throughout the term. Mother was not a known case of Hypertension, Diabetes Mellitus, Hypothyroidism. No H/O any insult (injury) at birth.
 Post delivery – till date. : Patient is born and brought up in Kadoli, Belagavi. No remarkable events since birth.
ï‚— She is good in studies, mingles with people easily. She gives debate and speaks freely without fear in-front of people and she has won in almost all the debate she has participated yet she is timid. She cannot takes / tolerates the pain when other people are quarrelling (reaction sympathetic). She is that sensitive she cannot even tolerate the fight in movies and serials. If she sees any beggar on road she tends to lend her tiffin.
General Physical Examination :
Patient is moderately built and moderately nourished, No pallor, cyanosis, icterus, clubbing, oedema, lymphadenopathy, Temperature : 98.6º F. (Afebrile), Thermals : Hot, Height :129cms, Weight :26kgs, Birth Weight : 2.75kgs, Pulse rate :84 bpm, Respiratory cycle : 18cpm.
Clinical diagnosis :Primary enerusis.
Totality of symptoms :
ï‚— Bedwetting at night and daytime.
ï‚— Desires spicy food.
ï‚— She cannot tolerate when other people are quarrelling (reaction - sympathetic), She is that sensitive she cannot even tolerate the fight in movies and serials. If she sees any beggar on road she tends to lend her tiffin
ï‚— Hot patient.
Analysis of symptoms :
Common symptoms Uncommon symptoms
Bed wetting. She cannot tolerate when other people are quarrelling.
Timid but speaks in public.
Desires spicy food

Prescription: Causticum200 HS 1dose
Basis of prescription : This case has been prescribed without repertorization as we found the substantial / peculiar symptom ( sensitive to emotional disturbances) for prescription while case taking.
Follow up’s : (written as it is expressed by father)
ï‚— 29/07/2019
Father said patient has passed urine only twice during her sleep since last week.
Complaints are better by 50%.
Prescribed Placebo BD for 15 days.
ï‚— 19/08/2019
Patient has passed urine during day sleep only once since past 10days.
No bedwetting at night since 10 days.
Appetite has improved, father said she herself asks and have food.
Patient is better by 75%.
Prescribed Placebo BD for 15 days.
ï‚— 03/09/2019
Bedwetting only once at day sleep and no bedwetting at night since 1 month.
Feeling generally better.
No fresh complaints.
Prescribed Placebo BD for 15 day.
Conclusion : Enuresis can be successfully treated with detailed homoeopathic case taking with individualised homoeopathic medicine along with encouragement, a positive attitude and motivation are important components of treatment to become dry. Punishment and criticism has no role to play in care. Children with enuresis get always benefit from a caring attitude of parents. A positive approach by the physician and care taker is also important role to play for putting confidence and to increase compliance.
References :
1. Ghai. O. P, BaggaArvind, Pual. V.K; Ghai essential paediatrics; 8th edition revised and enlarged; CBS Publications and distributors Pvt. Ltd.; NewDelhi; 2013, P-504.
2. Kliegman, M. Robert, Stanton, F. Bonita. Geme, St. Schor; Nelson Textbook of Paediatrics; 20th edition; ELSEVIER; Philadelphia; 2016;
3. http://dx.doi.org/10.5350/Sleep.Hypn.2019.21.0168. Sleep and hypnosis : a Journal of Clinical Neurosciences and Physiopathology.
From :
Dr Shashank H S
Dept of Paediatrics
PG Part 1
A M Shaikh Homoeopathic Medical College , PG Research Centre & Hospital, Belagavi.

Under the guidance of :
Dr Nahida M Mulla. M.D (HOM); MACH
Prof. and HOD Paediatrics
A M Shaikh Homoeopathic Medical College , PG Research Centre & Hospital, Belagavi.