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| NEPHROTIC SYNDROME
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Q.10)
How do you treat a relapse?
A.10) Then again oral prednisolone therapy may be needed.
The duration of course of prednisolone therapy for relapse is
shorter (6-8 weeks).
Q.11)
When do you start steroids in a relapse?
A.11) If a child has proteinuria of 2+ or more for 2-3 weeks
even if there is no swelling or edema it is safer to start steroids
rather than wait, because all the complications of NS are related
to edema.
Q.12)
When is a kidney biopsy required?
A.12) If the patient does not respond to oral prednisolone
therapy within the prescribed time a kidney biopsy is a must .
Q.13)
What is the role of levamisole & when do you start & how
to give?
A.
13) Levamisole is a drug, which is useful if NS relapses frequently
i.e. more than 3 relapses within 1 year or patient relapses while
on steroids i.e. Steroid dependent NS. Levamisole can control
proteinuria, which is reduced by steroids sparing effect so that
fewer doses of steroids is needed and in some cases steroids can
be omitted.
Levamisole is started when prednisolone has produced remission
(i.e. urine albumin shows nil or trace for 3 days consecutively).
The dose recommended is 2.5 mg/kg on alternate day for 6-18 months
with
tapering dose of steroids. It is to be given after dinner at bedtime.
Q.14) What is the role of Enalapril in NS?
A.14)
Tab.Enalapril is used to reduce proteinuria in selected cases of
NS with infections like hepatitis, peritonitis etc. in whom steroids
are contraindicated.
Q.15) If the child is Hbs Ag+ve do you give steroids? What is
the treatment?
A.15)
With HbsAg +ve, steroids are not indicated and may be harmful.
Tab.Enalapril can be tried in such cases.
Q.16)
What is the role of immunisation?
A.16)
Immunisations are advised when the child is not in relapse and
the dose of prednisolone is very small or when prednisolone is
stopped. Vaccines for chickenpox, hepatitis-B, H, influenzae and
pneumococci are important to prevent these infections which increase
risk to life in a child with NS.
Last updated on 6-11-2000
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