Glomerulonephritis edema

Edema Adjunctive therapy in edema associated with congestive heart failure (CHF), hepatic cirrhosis, and corticosteroid and estrogen therapy. Useful in edema due to renal dysfunction (eg, nephrotic syndrome, acute glomerulonephritis, chronic renal failure). 

Nephrotic syndrome is characterized by proteinuria and edema due to some form of glomerulonephritis. The resulting fall in plasma protein concentration decreases vascular volume, which leads to diminished renal blood flow. This in turn causes secondary aldosteronism characterized by Na and water retention and K+ depletion. Rigid control of dietary Na is essential. Therapy of the nephrotic syndrome using a thiazide (possibly with a K -sparing diuretic) to control the secondary aldosteronism, is a useful initial approach to treatment Since nephrotic edema is frequently more difficult to control than cardiac edema, it may be necessary to switch to a loop diuretic (and spironolactone) to obtain adequate diuresis. 

Renal function improvement. Decoction of the dried rhizome, taken orally by 15 patients with chronic renal failure resulting from chronic glomerulonephritis, polycystic disease, tuberculosis, or diabetes, at variable dosage levels, was active. The patients were dosed three times daily for 3 months with a combination of Zingiber officinale and Panax ginseng. Improvements were seen in blood urea nitrogen, edema, fatigue, nausea, and constipation without effect on hematocrit or albumin. The effect decreased after 6 months . ... 

Immunologic reactions to drugs resulting in serum sickness are more common than immediate anaphylactic responses, but type II and type III hypersensitivities often overlap. The clinical features of serum sickness include urticarial and erythematous skin eruptions, arthralgia or arthritis, lymphadenopathy, glomerulonephritis, peripheral edema, and fever. The reactions generally last... 

Calculi in the urinary tract Acute gastroenteritis Acute pancreatitis Lumbar pain Acute pyelonephritis Acute glomerulonephritis Acute renal failure Edema Acute appendicitis Peritonitis Trauma... 

Complement deficiencies are associated with several diseases. Alternative pathway deficiencies are rare, but when they exist more than one-half of factor D or properdin-deficient individuals suffer from Neisseria infections of which 75% are fatal. Individuals with deficiencies in the MAC components, e.g., C5, C6, Cl, and C8, are also susceptible to infection with Neisseria. Deficiencies in C1, C4, and C2 are associated with systemic lupus erythematosus and glomerulonephritis. Hereditary angioedema, a disease characterized by recurrent submucosal and subcutaneous edema, is caused by a deficiency in Cl inhibitor. Complexes and interactions similar to those of the complement system are also characteristic of the clotting system (Chapter 36). 

In the absence of specific and effective therapy for many types of glomerulonephritis, supportive treatments for edema, hypertension, hyperlipidemia, and intravascular thrombosis play important roles in alleviating the complications associated with the disease. 

In patients with nephrotic syndrome, dietary measures involve restriction of sodium intake to 50 to 100 mEq/day, protein intake of 0.8 to 1 g/day, and a low-lipid diet of less than 200 mg cholesterol. Total fat should account for less than 30% of daily total calories. Sodium restriction is important not only in the control of edema, but also in the control of hypertension and proteinuria. Similarly, protein restriction not only helps to reduce proteinuria, but also has a potential role in retarding the progression of renal disease. Patients should also stop smoking because a dose-dependent increase in risk for developing ESKD was observed in men with primary inflammatory (IgA glomerulonephritis) or noninflammatory (polycystic kidney disease) renal diseases. ... 

THERAPEUTIC USES Thiazide diuretics are used to treat edema associated with heart (congestive heart failure), liver (cirrhosis), and renal (nephrotic syndrome, chronic renal failure, and acute glomerulonephritis) disease. With the possible exceptions of metolazone and indapamide, most thiazide diuretics are ineffective when the GFR is <30-40 mL/min. 

Two cases of Henoch-Schonlein purpura (a disease that involves purple spots on the skin, joint pain, gastrointestinal problems, and glomerulonephritis) have been reported in individuals that were using aloe. One patient had taken "some juice extracted from four to five leaflets of Aloe vera" (he had taken the same remedy several months prior with no reaction) 24 hours prior to developing a rash, abdominal pain followed by rapid deterioration of renal function and abnormal levels of serum creatinine (Cholongitas et al. 2005). The second patient had taken "extracts of Aloe vera" (parts consumed and dose consumed unspecified) for approximately 1 week. He developed general edema and palpable purpura that eventually resolved (Cao et al. 2005). 

Kidney disease is observed in 16% to 49% of CSS patients, usually presenting as rapidly progressive glomerulonephritis with necrosis, crescents, or both (2,3,37,38). Interstitial eosinophil and neutrophil infiltration with edema is also possible. Although mostly associated with anti-MPO Ab (2,3), it is a pauci-immune glomerulonephritis. Other renal manifestations include proteinuria, hypertension, renal insufficiency, and/or renal infarction with or without microaneurysms (1,4,16,22-24,36,38). 

The nephrotic syndrome, which occurs most frequently in the course of chronic glomerulonephritis, is characterized by marked albuminuria, edema, hypoalbuminemia, and hypercholesterolemia (191). Extensive studies of the serum and urinary proteins in this disorder have proved fruitful in clarifying some of the disease mechanisms involved although the basic metabolic disturbance underlying the syndrome remains unknown. 

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