Drug Induced Subacute Cutaneous Lupus Erythematosus

Psariasis

Annular patterns are particularly likely to be found in psoriasis when individual lesions undergo resolution. In such a situation the central portion of a plaque fades, leaving an erythematous border at the periphery. This border is generally wider (5 to 8 mm) than that found in the other annular diseases, and there is a tendency for the border to break up into individual papules. The size of the annular lesions and their configuration depend on the appearance of the plaque that preceded them. Since annularity usually occurs during resolution, centrifugal growth is not commonly seen. Typical psoriatic scale is usually present on the border, but when the disease is under active treatment, the formation of scale is minimal or absent. Diagnosis is not ordinarily difficult, since more typical lesions of psoriasis can be found elsewhere on the body.

Tinea Corparis

Annular lesion’s are found in Microsporum. sp. infections of children and in TrichoPhyton rubrum. infections of adults. In children the lesions are solitary or are few in number. They are usually only 2 to 4 cm in diameter and are generally found on exposed surfaces. Complete circles are formed, and there is relatively little tendency for coalescent growth of adjacent lesions. Scale is always present at the active border. The amount of inflammation and thus the intensity of the redness are highly variable. Potassium hydroxide (KOH) preparations, fungal cultures, or both should be carried out to confirm a clinical diagnosis.

The annular lesions of tinea corporis in adults are quite different. Larger rings are noted, and coalescent growth frequently results in the development of very large lesions with serpiginous borders. Complete circles are not often found, and in fact, gaps in the ring-like border may be large enough to interfere with recognition of the annular pattern. The active, advancing border is quite narrow (1 to 3 mm) and is usually scaling. Postinflammatory hyperpigmentation may be found within the central portion of the lesions as centrifugal growth occurs. New circles can sometimes redevelop in the cleared central area of the larger rings. Tinea corporis in the adult usually begins on the upper, inner thighs and from there extends onto the buttocks and lower trunk around the belt line. Less commonly, the face or dorsal surface of the hands may be involved. The disease is pruritic, and excoriations (fungal eczema) are often present. KOH preparations, fungal cultures, or both should be used to confirm a clinical diagnosis.
Lupus Erythematosus

The lesions of discoid Lupus Erythematosus (LE) regularly assume an annular configuration when the central portions of otherwise-solid plaques begin to undergo resolution. This resolution often results in the development of hypopigmentation and scarring in the central area. The presence of scarring is a pathognomonic feature of discoid LE. Some of these annular plaques are stable in size, while others show evidence of very slow centrifugal growth. The active border is usually thin, with some evidence of scale formation. Most lesions are 2 to 5 cm in diameter. Lesions are most often found on the face, scalp, and neck, but occasionally the upper trunk and arms are involved. A clinical diagnosis can be confirmed by biopsy.

Annular lesions are also seen in subacute cutaneous LE and, sometimes, in systemic LE. They are located on the trunk and proximal arms rather than on the face and scalp. These lesions greatly resemble those of the gyrate erythemas . On the other hand, they lack the central hypopigmentation and scarring found in discoid-type disease. Pityriasis Hosea. The herald patch of pityriasis rosea regularly demonstrates an annular configuration. The border is brown-red, and fine (pityriasis-type) scale is present. The lesion is usually 3 to 5 cm in diameter and, once present, does not grow in size. The herald patch when seen in the presence of full-blown pityriasis rosea is not difficult to recognize. Unfortunately, when it occurs before the rest of the disease develops, it is easily misdiagnosed as tinea corporis. KOH preparations will, of course, distinguish between the two. The smaller lesions of pityriasis rosea are only rarely annular.

Lichen Planus

Ringed lesions are sometimes seen in lichen planus, but they are generally outnumbered by more typical flat-topped papules and plaques. Annular lesions when present are quite small, rarely measuring more than 2 or 3 cm in diameter. Both partial and complete circles may be formed. It is sometimes possible to distinguish, within the annulus, individual papules that have not completely coalesced. The color is distinctively violaceous, and the surface is shiny because of the reflective properties of compacted lichenoid scale. Annular lesions are particularly likely to be found on the volar surface of the wrists and on the shaft of the penis. The presence of one or more linear lesions occurring as a result of the Koebner phenomenon is a very helpful diagnostic sign. Biopsy is pathognomonic.

Secandary SyPhilis

Annular lesions are occasionally seen in secondary syphilis. As in lichen planus, the annular lesions are small, with most being less than 2 cm in diameter. The color is red rather than violaceous. Linear lesions are not found. The annular lesions of secondary syphilis are particularly common on the face and genitalia. Clinical recognition is assisted by the regular presence of other symptoms and signs of secondary syphilis. The serologic test for syphilis will be positive. Biopsy of the lesions is highly distinctive.

Discoid Lupus Erythematosus Treatment Dogs

This form of lupus mostly affects women from 18 to 50 years. The cases of men suffering from discoid lupus erythematosus are very rare. The racial factor seems to be decisive: the majority of patients are black American women and the symptoms are much more severe in their case. We cannot be certain about the real causes of this disease but there are several risk factors like the hormonal factors (such as estrogen excess), genetic factors and environmental factors (antibiotic long term treatment). The genetic factors have a particularly increased influence on the apparition of discoid lupus erythematosus compared to the other lupus forms.

Discoid lupus erythematosus appears under the form of large size lesions with circular aspect. Like all types of lupus, it also has an auto immune character: the immune system doesn’t protect the body from the viruses or bacteria but attacks its healthy tissues, which causes skin lesions. Long term solar exposure significantly worsens discoid lupus. The neck, face, arms and scalp are the most affected areas in which the lesions appear. But it is not compulsory for them to be the only parts: lesions may also appear on the back, legs or chest, which suggests the evolution into systemic lupus erythematosus.

Systemic lupus erythematosus – unlike discoid lupus erythematosus that only affects the skin – can generate a series of severe disorders: tuberculosis, cardiovascular diseases, gastrointestinal problems, pneumonia, musculoskeletal or nervous system problems.

The diagnosis of discoid lupus erythematosus is only given after previous physical exams, analysis performed in laboratory on skin samples and complicated blood tests. The adequate medication will be given once the diagnosis is confirmed by the test results. Contemporary medicine doesn’t have yet a cure for this condition but it may be kept under control and its signs – improved. But in order to have the best possible treatment result and to avoid the worsening of the lesion and a permanent scar formation, a patient with this condition must absolutely stay away from solar light.

The skin lesions that appear in the first phases of discoid lupus erythematosus are circular and reddish, with prominent borders. The next stages cause the scales and crusts on the skin’s surface. In case it affected the scalp, the hair is lost; this may be temporary or permanent. The most at risk category is the black American population because they have more chances to develop skin cancer than others. The proper medication, doubled by the protection against sunlight will keep the disease controlled and an obvious improvement of the symptoms will be noticed.

Systematic Lupus Erythematosus Disease Activity Index

Respiratory system: Shortness of breath and increased blood pressure in the lungs Nervous system: Anxiety, depression, memory loss, headaches, and confusion Other symptoms: Fever, severe weight changes, dry eyes and fatigue

Types of Lupus

There are 4 types of lupus and the symptoms are generally correlated with the specific type of lupus the sufferer has.
Systemic Lupus Erythematosus: The most common form of lupus that affects nearly all parts of the body, but can range from mild to severe.Discoid (Cutaneous) Lupus Erythematosus: This form of lupus is limited to the skin and mouth. Rashes and lesions spread throughout your body with discoid lupus. The rashes are generally scaled, elevated and red, but they do not itch and are circular shaped. They may spread over the cheeks and bridge of yours nose creating what is known as a butterfly rash. Drug-induced Lupus Erythematosus: Certain drugs have been found to react badly in certain patients and create lupus. These sufferers will experience similar symptoms to systematic lupus but with their body systems and organs undamaged. These drugs may include hydralazine, procainamide, and isoniazid. The symptoms usually disappear after medication is stopped for 6 months.Neonatal Lupus: Neonatal lupus is an uncommon disease that affects infants of women who have lupus. Infants experience skin rashes, liver problems and low blood cell counts at birth that continue for several months and then disappear with no lasting damage. It is relatively uncommon and most women with lupus deliver healthy babies.
Living with Lupus

The severity and frequency of flare-ups highly determines how easily lupus sufferers can live with the disease. It is most important to listen to your doctor, try to stay healthy and follow general precautions.

The autoimmune nature of lupus makes it essential that you try to stay away from any viruses or colds going around. Taking vitamins, eating healthy, washing your hands, getting enough sleep and maintaining good mental health can help your body stay in top shape and avoid getting sick and having a flare-up.

Exercising regularly is vital for keeping the body healthy. While this may be difficult due to the joint pain and fatigue that sometimes comes with lupus, there are a number of light, low-impact excises like yoga, walking and swimming that can be performed to keep the body healthy. For joint pain or to prevent injury, it’s important to have the right orthopedic braces and supports.

For severe joint pain or damage, a contracture management brace contracture management brace may be a better option. These are for muscles and joints that have been unused for a prolonged time.

Lupus sufferers are affected by sun exposure and should try to stay away from the sun at the hottest hours (noon-3pm) and protect their skin with sunscreen or clothing when in the sun. Those with lupus should get immunizations and vaccinations seasonally and take care of and cuts that could be infected. Smoking increases the chance of flare-ups and should be avoided.

Having lupus is difficult, but with the right care, it is manageable. It’s important to stay positive, listen to your doctor and take care of your body. With the right care and medication, you can minimize the effects of lupus and live a normal life.

Discoid Lupus Erythematosus (dle)

Lupus is a chronic inflammatory disease that often affects many of the body’s organs. An autoimmune disease, it occurs when the immune mechanism forms antibodies that attack the body’s own tissues. The majority of experts believe that lupus is caused by a virus that has yet to be identified. According to this theory, the immune system develops antibodies in response to the virus that proceed in attacking the body’s own organs and tissues. This causes inflammation of the skin, blood vessels, joints, and other tissues to result. Other possible contributing factors to the development of lupus include heredity and estrogen and testosterone hormones.

This disease was named lupus, which means wolf, due to the butterfly-shaped rash that many people get over their cheeks and nose, which gave them what many people considered to be a wolf-like appearance. However, the rashes may appear elsewhere on the body, including the chest, ears, hands, shoulders, and upper arms. At least 90 percent of those people who contract lupus are women, with women of Asian background appearing to be at greater risk for developing lupus than other women. Although lupus may occur at any age, it usually develops between the ages of fifteen and thirty-five.

There are two different types of lupus: systemic lupus erythematosus (SLE) and discoid lupus erythematosus (DLE). SLE is a systemic disease that affects many different parts of the body and severity ranging from mild to life-threatening. The first symptoms in many cases of SLE seem to resemble those of arthritis, with swelling and pain in the fingers and other joints. The disease can also appear suddenly, with acute fever and the characteristic red rash appearing across the cheeks. Additionally, there may be red, scaling lesions elsewhere on the body, with sores possibly forming in the mouth.

Other symptoms of SLE include abdominal and chest pains, blood in the urine, fatigue, hair loss, loss of appetite, low-grade fever, nausea, poor circulation in the fingers and toes, shortness of breath, ulcers, vomiting, and weight loss. Many times, the lungs and kidneys are also involved, as about 50 percent of those with SLE develop nephritis, which is inflammation of the kidneys. The brain, lungs, spleen, and heart may also be affected in serious cases. Additionally, SLE can cause excessive bleeding and an increased susceptibility to infection. Amnesia, deep depression, headaches, mania, paralysis, paranoia, psychosis, seizures, and stroke may also be present if the central nervous system is involved.

DLE is a less serious disease, which primarily affects the skin. The butterfly rash forms over the nose and cheeks, with other possible lesions elsewhere, primarily on the scalp and ears. These lesions, which are small, yellowish lumps, can recur or persist for years. When they disappear, they often leave scars or permanent bald patches on the scalp. Although DLE is not necessarily dangerous to overall health, it is a chronic and disfiguring skin disease.

Both types of lupus follow a pattern of periodic flare-ups, with alternating periods of remission. These flare-ups can be caused by the sun’s ultraviolet rays, fatigue, pregnancy, childbirth, infection, some drugs, stress, unidentified viral infections, and chemicals.

In order for a diagnosis to be made, the following eight symptoms have to occur either separately or at the same time: abnormal cells in the urine; arthritis; butterfly rash on the cheeks; low white blood cell count, low platelet count, or hemolytic anemia; mouth sores; seizures of psychosis; sun sensitivity; and the presence of blood of a specific antibody that is found in 50 percent of people with lupus.

The following nutrients are considered to be extremely important in dealing with lupus: calcium, magnesium, l-cysteine, proteolytic enzymes (Serrapeptase and nattokinase), essential fatty acids, glucosamine sulfate, garlic, raw thymus glandular, vitamin C with bioflavonoids, zinc, acidophilus, kelp, a multivitamin and mineral complex, pycnogenol, vitamin A, vitamin E, alfalfa, goldenseal, burdock root, feverfew, pau d’arco, red clover, licorice root, milk thistle, and yucca.

Natural alternatives can help support the body in the fight against lupus, but one should always consult a physician before taking matters into their own hands regarding this disease. Natural supplements like the ones listed above can all be found at your local or internet health food store.

*Statements contained herein have not been evaluated by the Food and Drug Administration. Vitamins and herbs are not intended to diagnose, treat and cure or prevent disease. Always consult with your professional health care provider before changing any medication or adding Vitamins to medications.


Systematic Lupus Erythematosus Treatment

Respiratory system: Shortness of breath and increased blood pressure in the lungs Nervous system: Anxiety, depression, memory loss, headaches, and confusion Other symptoms: Fever, severe weight changes, dry eyes and fatigue

Types of Lupus

There are 4 types of lupus and the symptoms are generally correlated with the specific type of lupus the sufferer has.
Systemic Lupus Erythematosus: The most common form of lupus that affects nearly all parts of the body, but can range from mild to severe.Discoid (Cutaneous) Lupus Erythematosus: This form of lupus is limited to the skin and mouth. Rashes and lesions spread throughout your body with discoid lupus. The rashes are generally scaled, elevated and red, but they do not itch and are circular shaped. They may spread over the cheeks and bridge of yours nose creating what is known as a butterfly rash. Drug-induced Lupus Erythematosus: Certain drugs have been found to react badly in certain patients and create lupus. These sufferers will experience similar symptoms to systematic lupus but with their body systems and organs undamaged. These drugs may include hydralazine, procainamide, and isoniazid. The symptoms usually disappear after medication is stopped for 6 months.Neonatal Lupus: Neonatal lupus is an uncommon disease that affects infants of women who have lupus. Infants experience skin rashes, liver problems and low blood cell counts at birth that continue for several months and then disappear with no lasting damage. It is relatively uncommon and most women with lupus deliver healthy babies.
Living with Lupus

The severity and frequency of flare-ups highly determines how easily lupus sufferers can live with the disease. It is most important to listen to your doctor, try to stay healthy and follow general precautions.

The autoimmune nature of lupus makes it essential that you try to stay away from any viruses or colds going around. Taking vitamins, eating healthy, washing your hands, getting enough sleep and maintaining good mental health can help your body stay in top shape and avoid getting sick and having a flare-up.

Exercising regularly is vital for keeping the body healthy. While this may be difficult due to the joint pain and fatigue that sometimes comes with lupus, there are a number of light, low-impact excises like yoga, walking and swimming that can be performed to keep the body healthy. For joint pain or to prevent injury, it’s important to have the right orthopedic braces and supports.

For severe joint pain or damage, a contracture management brace contracture management brace may be a better option. These are for muscles and joints that have been unused for a prolonged time.

Lupus sufferers are affected by sun exposure and should try to stay away from the sun at the hottest hours (noon-3pm) and protect their skin with sunscreen or clothing when in the sun. Those with lupus should get immunizations and vaccinations seasonally and take care of and cuts that could be infected. Smoking increases the chance of flare-ups and should be avoided.

Having lupus is difficult, but with the right care, it is manageable. It’s important to stay positive, listen to your doctor and take care of your body. With the right care and medication, you can minimize the effects of lupus and live a normal life.

Neonatal Lupus Erythematosus Congenital Heart Block

What is lupusc
Systemic lupus erythematosus, also known as SLE, or simply lupus, is a disease that is characterized by periodic episodes of inflammation of and damage to the joints, tendons, other connective tissues, and organs, including the heart, lungs, blood vessels, brain, kidneys, and skin. The heart, lungs, kidneys, and brain are the organs most affected. Lupus affects each individual differently and the effects of the illness range from mild to severe. Lupus is an autoimmune disease that occurs in about one in 1,000 people. It is much more common in women of childbearing age, especially African-American women.
What are the symptoms of lupusc
The following are the most common symptoms of lupus. However, each individual may experience symptoms differently. Symptoms may include:
malar rash – a rash shaped like a butterfly that is usually found on the bridge of the nose and the cheeks.discoid rash – a raised rash found on the head, arms, chest, or back.feverinflammation of the jointssunlight sensitivityhair lossmouth ulcersfluid around the lungs, heart, or other organskidney problemslow white blood cell or low platelet countRaynaud phenomenon – a condition in which the blood vessels of the fingers and toes go into spasm when triggered by factors such as cold, stress, or illness.weight lossnerve or brain dysfunctionanemia
The symptoms of lupus may resemble other medical conditions or problems. Always consult your physician for a diagnosis.
How is lupus diagnosedc
In addition to a complete medical history and physical examination, lupus may be diagnosed by symptoms and by blood tests for antibodies specific for the disease. The course of the disease ranges from mild to severe and most people have periods of increased symptoms called flares.
How does pregnancy affect lupusc
Pregnancy may or may not increase the symptoms of, or change the course of, lupus. Flares may occur at any time in pregnancy or the postpartum period (after delivery), but are usually mild.
How does lupus affect pregnancyc
Lupus can affect pregnancy at any stage. It is not clear whether the severity of the disease or the type of medication causes problems. However, there are higher pregnancy risks associated with lupus. The rate of miscarriage is higher, ranging from 9 to 40 percent. Later pregnancy loss may also be more likely. Pregnancy complications that may be increased in women with lupus include, but are not limited to, the following:
miscarriagepreterm delivery, especially with a lupus flarepremature rupture of membranes (early breaking of the amniotic sac)pregnancy-induced hypertension (high blood pressure of pregnancy)intrauterine growth restriction (poor fetal growth)stillbirth
It is thought that high levels of antiphospholipid antibodies (antibodies that cause abnormal blood clotting) may be linked with stillbirth. Pregnancy loss may also be associated with the severity of lupus at the time of conception, or if lupus begins during pregnancy. It is also thought that kidney disease with lupus may play a role in pregnancy loss.

A rare condition called neonatal lupus erythematosus (NLE) may affect babies of mothers with lupus. Symptoms may include:
congenital heart block – a problem in the heart’s electrical system that causes the heart to be slower than normal. This affects about 5 percent of newborns who have no other heart defect.skin rashes on the face, scalp, chest and upper back (these usually go away in the first year)blood abnormalities including anemia, low platelets, and lowered white blood cell countManagement of lupus during pregnancy:
Because of the higher risks for pregnancy loss with lupus, mothers need close monitoring of the disease. More frequent prenatal visits are often needed.

Medications used to treat lupus may need to be changed (type and/or dosage), during pregnancy. Consult your physician for more information.

Testing during pregnancy with lupus may include the following:
blood tests for lupus (specific antibodies that help track the severity of the disease)monitoring for signs of pregnancy-induced hypertensionultrasound – a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels used to monitor fetal growth and development.fetal heart monitoring (to check the fetal heart rate for signs of distress)
Women with lupus can increase their chances for a healthy pregnancy by getting early prenatal care and working with their healthcare providers in the management of their disease.
Lupus death rate jumps:
There has been a sharp increase in deaths from lupus that is concerning government health officials. Reported in the Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC), the death rate from lupus increased by 35 percent over two decades. The greatest increase occurred among middle-aged black women, among whom the death toll rose by almost 70 percent.

Unfortunately experts have no clear explanation for the increase in the death rate. The CDC is considering establishing a special registry, which may help determine whether the increased death rate is real or comes from better recognition of the condition.

Discover How You Can Treat Infertility Naturally, Without Drugs or Surgery


A Look At Discoid Lupus Erythematosus

This form of lupus mostly affects women from 18 to 50 years. The cases of men suffering from discoid lupus erythematosus are very rare. The racial factor seems to be decisive: the majority of patients are black American women and the symptoms are much more severe in their case. We cannot be certain about the real causes of this disease but there are several risk factors like the hormonal factors (such as estrogen excess), genetic factors and environmental factors (antibiotic long term treatment). The genetic factors have a particularly increased influence on the apparition of discoid lupus erythematosus compared to the other lupus forms.

Discoid lupus erythematosus appears under the form of large size lesions with circular aspect. Like all types of lupus, it also has an auto immune character: the immune system doesn’t protect the body from the viruses or bacteria but attacks its healthy tissues, which causes skin lesions. Long term solar exposure significantly worsens discoid lupus. The neck, face, arms and scalp are the most affected areas in which the lesions appear. But it is not compulsory for them to be the only parts: lesions may also appear on the back, legs or chest, which suggests the evolution into systemic lupus erythematosus.

Systemic lupus erythematosus – unlike discoid lupus erythematosus that only affects the skin – can generate a series of severe disorders: tuberculosis, cardiovascular diseases, gastrointestinal problems, pneumonia, musculoskeletal or nervous system problems.

The diagnosis of discoid lupus erythematosus is only given after previous physical exams, analysis performed in laboratory on skin samples and complicated blood tests. The adequate medication will be given once the diagnosis is confirmed by the test results. Contemporary medicine doesn’t have yet a cure for this condition but it may be kept under control and its signs – improved. But in order to have the best possible treatment result and to avoid the worsening of the lesion and a permanent scar formation, a patient with this condition must absolutely stay away from solar light.

The skin lesions that appear in the first phases of discoid lupus erythematosus are circular and reddish, with prominent borders. The next stages cause the scales and crusts on the skin’s surface. In case it affected the scalp, the hair is lost; this may be temporary or permanent. The most at risk category is the black American population because they have more chances to develop skin cancer than others. The proper medication, doubled by the protection against sunlight will keep the disease controlled and an obvious improvement of the symptoms will be noticed.


Discoid Lupus Erythematosus Sle Definition

Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein[1] (proteinuria at least 3.5 grams per day per 1.73m2 body surface area)[2] from the blood into the urine.
Definition : Nephrotic syndrome is a group of symptoms including protein in the urine (more than 3.5 grams per day), low blood protein levels, high cholestrol levels, and swelling. The urine may also contain fat, which can be seen under the microscope.
Kidneys affected by nephrotic syndrome have small pores in the podocytes, large enough to permit proteinuria (and subsequently hypoalbuminemia, because some of the protein albumin has gone from the blood to the urine) but not large enough to allow cells through (hence no hematuria). By contrast, in nephritic syndrome, RBCs pass through the pores, causing hematuria.

Causes, incidence, and risk factors :

Nephrotic syndrome is caused by various disorders that damage the kidneys, particularly the basement membrane of the glomerulus. This immediately causes abnormal excretion of protein in the urine.

The most common cause in children is minimal change Disease, while membranous glomerulonephritis is the most common cause in adults.

This condition can also occur as a result of infection, use of certain drugs,caner, genetic disorders, immue disorders, or diseases that affect multiple body systems including diabetes, multiple myeloma, and amyloidosis.

It can accompany kidney disorders such as glomerulonephritis, focal and segmental glomerulosclerosis, and mesangiocapillary glomerulonephritis.

Nephrotic syndrome can affect all age groups. In children, it is most common from age 2 to 6. This disorder occurs slightly more often in males than females.


Presentation
:

It is characterized by proteinuria (>3.5g/day), hypoalbuminemia, hyperlipidemia and edema. A few other characteristics are:

common sign is excess fluid in the body. This may take several forms:
Puffiness around the eyes, characteristically in the morning.
Edema over the legs which is pitting (i.e., leaves a little pit when the fluid is pressed out, which resolves over a few seconds).
Fluid in the pleural cavity causing pleural effusion. More commonly associated with excess fluid is pulmonary edema.
Fluid in the peritoneal cavity causing ascites.
Hypertension (rarely)
Some patients may notice foamy urine, due to a lowering of the surface tension by the severe proteinuria. Actual urinary complaints such as hematuria or oliguria are uncommon, and are seen commonly in nephritic syndrome.
May have features of the underlying cause, such as the rash associated with Systemic Lupus Erythematosus, or the neuropathy associated with diabetes.
Examination should also exclude other causes of gross edemaa€”especially the cardiovascular and hepatic system.

Investigations
:

The following are baseline, essential investigations

Urine sample shows proteinuria (>3.5 per 1.73 m2 per 24 hour). It is also examined for urinary casts; which is more a feature of active nephritis.
Comprehensive metabolic panel (CMP) shows Hypoalbuminemia: albumin level ?2.5g/dL (normal=3.5-5g/dL).
High levels of cholesterol (hypercholesterolemia), specifically elevated LDL, usually with concomitantly elevated VLDL
Electrolytes, urea and creatinine (EUCs): to evaluate renal function
Further investigations are indicated if the cause is not clear

Biopsy of kidney :

Auto-immune markers (ANA, ASOT, C3, cryoglobulins, serum electrophoresis)

Classification and causes :
Nephrotic syndrome has many causes and may either be the result of a disease limited to the kidney, called primary nephrotic syndrome, or a condition that affects the kidney and other parts of the body, called secondary nephrotic syndrome.


Primary causes
:
Primary causes of nephrotic syndrome are usually described by the histology, i.e., minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS) and membranous nephropathy (MN).

They are considered to be a€œdiagnoses of exclusiona€, i.e., they are diagnosed only after secondary causes have been excluded.

Secondary causes
:
Secondary causes of nephrotic syndrome have the same histologic patterns as the primary causes, though may exhibit some differences suggesting a secondary cause, such as inclusion bodies.

They are usually described by the underlying cause.

Secondary causes :

Hepatitis B
SjA¶gren’s syndrome
Systemic lupus erythematosus (SLE)
Diabetes mellitus
Sarcoidosis
Syphilis
Drugs
Malignancy (cancer)
Focal segmental glomerulosclerosis (FSGS)[3]
Hypertensive Nephrosclerosis
Human immunodeficiency virus (HIV)
Diabetes mellitus
Obesity
Kidney loss
Minimal change disease (MCD)[3]
Drugs
Malignancy, especially Hodgkin’s lymphoma

Differential diagnosis of gross edema:

When someone presents with generalized edema, the following causes should be excluded:
Heart failure: The patient is older, with a history of heart disease. Jugular venous pressure is elevated on examination, might hear heart murmurs. An echocardiogram is the gold standard investigation.
Liver failure: History suggestive of hepatitis/ cirrhosis: alcoholic, IV drug user, some hereditary causes.
Stigmata of liver disease are seen: jaundice (yellow skin and eyes), dilated veins over umbilicus (caput medusae), scratch marks (due to widespread itching, known as a€œpruritusa€), enlarged spleen, spider angiomata, encephalopathy, bruising, nodular liver
Acute fluid overload in someone with kidney failure: These people are known to have kidney failure, and have either drunk too much or missed their dialysis.
Metastatic cancer: When cancer seeds the lungs or abdomen it causes effusions and fluid accumulation due to obstruction of lymphatics and veins as well as serous exudation. iagnosis

Diagnosis is based on blood and urine tests and sometimes imaging of the kidneys, a biopsy of the kidneys, or both.

Treatment includes:
General measures (supportive)

Monitoring and maintaining euvolemia (the correct amount of fluid in the body):
monitoring urine output, BP regularly
fluid restrict to 1L
diuretics (IV furosemide)
Monitoring kidney function:
do EUCs daily and calculating GFR
Prevent and treat any complications [see below]
Albumin infusions are generally not used because their effect lasts only transiently.
Prophylactic anticoagulation may be appropriate in some circumstances.[4]

Specific treatment of underlying cause:

Immunosupression for the glomerulonephritides (corticosteroids[5], cyclosporin).
Standard ISKDC regime for first episode: prednisolone -60 mg/m2/day in 3 divided doses for 4 weeks followed by 40 mg/m2/day in a single dose on every alternate day for 4 weeks.
Relapses by prednisolone 2 mg/kg/day till urine becomes negative for protein. Then, 1.5 mg/kg/day for 4 weeks.
Frequent relapses treated by: cyclophosphamide or nitrogen mustard or cyclosporin or levamisole.
Achieving stricter blood glucose control if diabetic.
Blood pressure control. ACE inhibitors are the drug of choice. Independent of their blood pressure lowering effect, they have been shown to decrease protein loss.  Dietary recommendations
This section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unverifiable material may be challenged and removed. (August 2008)

Reduce sodium intake to 1000-2000 milligrams daily. Foods high in sodium include salt used in cooking and at the table, seasoning blends (garlic salt, Adobo, season salt, etc.) canned soups, canned vegetables containing salt, luncheon meats including turkey, ham, bologna, and salami, prepared foods, fast foods, soy sauce, ketchup, and salad dressings. On food labels, compare milligrams of sodium to calories per serving. Sodium should be less than or equal to calories per serving.

Eat a moderate amount of high protein animal food: 3-5 oz per meal (preferably lean cuts of meat, fish, and poultry)

Avoid saturated fats such as butter, cheese, fried foods, fatty cuts of red meat, egg yolks, and poultry skin. Increase unsaturated fat intake, including olive oil, canola oil, peanut butter, avocadoes, fish and nuts. Eat low-fat desserts.

Increase intake of fruits and vegetables. There is no potassium or phosphorus restriction necessary.

Monitor fluid intake, which includes all fluids and foods that are liquid at room temperature. Fluid management in nephrotic syndrome is tenuous, especially during an acute flare.

Complications
:

Venous thrombosis: due to leak of anti-thrombin 3, which helps prevent thrombosis. This often occurs in the renal veins. Treatment is with oral anticoagulants (not heparin as heparin acts via anti-thrombin 3 which is lost in the proteinuria so it will be ineffective.)
Infection: due to leakage of immunoglobulins, encapsulated bacteria such as Haemophilus influenzae and Streptococcus pneumonia can cause infection.
Acute renal failure is due to hypovolemia. Despite the excess of fluid in the tissues, there is less fluid in the vasculature. Decreased blood flow to the kidneys causes them to shutdown. Thus it is a tricky task to get rid of excess fluid in the body while maintaining circulatory euvolemia.
Pulmonary edema: again due to fluid leak, sometimes it leaks into lungs causing hypoxia and dyspnoea.
Growth retardation: does not occur in MCNS.It occurs in cases of relapses or resistance to therapy. Causes of growth retardation are protein deficiency from the loss of protein in urine, anorexia (reduced protein intake), and steroid therapy (catabolism).
Vitamin D deficiency can occur. Thyroxine is reduced due to decreased thyroid binding globulin.
Microc

http://www.homeopathyonline.in/kidneydisease.htmytic hypochromic anaemia is typical. It is iron-therapy resistant.

http://www.homeopathyonline.in/kidneydisease.htm

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Cutaneous Lupus Erythematosus Issues Diagnosis Treatment

Autoimmune progesterone dermatitis (APD) is a circumstance in which the menstrual rhythm is associated with an amount of rind findings such as urticaria, eczema, angioedema, and others. The circumstance presents with a kind of rind eruptions characterized by cyclical recurrent premenstrual exacerbations payable to progesterone variation during the menstrual rhythm. Autoimmune progesterone dermatitis usually presents during early adult life, and the disease may periodically go into spontaneous remission. Exogenous progesterone (eg, in oral contraceptives containing progestational agents like norethindrone or synthetic progestogens like norgestrel or levonorgestrel) may aggravate the skin eruptions of autoimmune progesterone dermatitis. Some women with chronic urticaria experience cyclical exacerbations of their skin condition corresponding with the menstrual cycle, and it is possible that progesterone plays a role in this process.

Severity of symptoms can change from almost imperceptible to anaphylactic in nature, and symptoms can be liberal. There are no particular histological features on biopsy in autoimmune progesterone dermatitis. The age of onslaught is varying, with the earliest age reported at menarche. The symptoms of APD correlate with progesterone levels during the luteal phase of the menstrual cycle. Symptoms may first appear, improve, or worsen during pregnancy and the peripartum period. In addition, autoimmune progesterone dermatitis during pregnancy has been associated with spontaneous abortions. This disease may become worse during pregnancy. Autoimmune progesterone dermatitis must be differentiated from perimenstrual flares of skin diseases such as acne, dermatitis herpetiformis, erythema multiforme, lichen planus, lupus erythematosus, psoriasis and estrogen dermatitis.

The diagnosis of Autoimmune progesterone dermatitis requires a proper clinical story accompanied by an intradermal injection examination with progesterone. Autoimmune progesterone dermatitis is normally impervious to traditional therapy such as antihistamines. The use of systemic glucocorticoids, usually in high doses, has been reported to control the cutaneous lesions of APD is some studies, but not in others. Oral contraceptives are often tried as initial therapy, but have had limited success, possibly due to the fact that virtually all oral contraceptives have a progesterone component. Conjugated estrogens have also been used in the treatment of autoimmune progesterone dermatitis. Tamoxifen, a nonsteroidal antiestrogen agent, may be effective in some patients but may cause amenorrhea. In some cases, the eruptions often settle spontaneously after a period of successful treatment.


Discoid Lupus Erythematosus Mayo Clinic

A variety of disorders can cause pleuritic chest pain, oftenwith a pleural rub, but without a pleural effusion. Some ofthese conditions remain ‘dry’ but in most fluid may accumulate,and therefore many of the causes of a pleural effusionmust be considered in the differential diagnosis of drypleurisy.

Pleuritic pain is a common feature of many radiologicallyobvious pneumonias, but can also occur with minorbacterial and viral pulmonary infections not radiologically apparent. Epidemic myalgia (Bornholm’s disease), mostcommonly due to the Coxsackie B virus, is primarily aninfection of intercostal muscle but occasionally the pleurais involved. The intercostal muscles are tender. There maybe associated pericarditis, myocarditis or orchitis. Pain mayrelapse and remit several times before finally settling.

PNEUMOTHORAX

Pneumothorax is air in the pleural space, as a consequenceof which there is partial or complete collapse of the lung.Owing to the recoil of the chest wall and the lung, the pressurewithin the pleural space is normally negative. Whenthe pleural membrane (visceral or parietal) is breached, airis sucked into the pleural cavity and the lung collapses.When the defect in the pleura seals, the pneumothorax isclosed and there is no movement of air in or out of thepleural cavity. When there is a persistent defect in thepleura the pneumothorax is open. When this defect is ofthe visceral pleura there is then a bronchopleural fistula,and air moves in and out of the pleural space duringbreathing. Occasionally the damaged visceral pleura actsas a valve, permitting air to enter the pleural space oninspiration but not to leave it on expiration, leading to atension pneumothorax.

A pneumothorax may be spontaneous, or follow chesttrauma, mechanical ventilation, ruptured oesophagus, orartificial induction. Causes of traumatic pneumothoraxinclude blunt trauma to the chest, commonly externalcardiac massage, and penetrating chest injuries (e.g. stabwounds or needle aspiration biopsies that breach thevisceral pleura from without) and transbronchial biopsyand positive-pressure ventilation that breach the visceralpleura from within.

Clinical featuresCharacteristically, there is a sudden onset of chest painlaterally, sometimes radiating to the shoulder. With substantialcollapse of the lung there is associated breathlessness,and a dry, irritating cough is common. Sometimes thepatient is aware of the partially collapsed lung floppingabout within the thorax. On examination the most strikingfindings are of reduced breath sounds and hyperresonantpercussion. A small left-sided pneumothorax may be associatedwith a clicking noise with each heartbeat, noted bythe patient and on occasions loud enough to be heard byothers. A large pneumothorax in a normal person causesbreathlessness, and in the presence of pre-existing pulmonarydisease a small one may cause severe respiratorydistress.Tension pneumothorax is a medical emergency. Thevalve action of the pleural tear results in a progressiveincrease in the size and pressure of the pneumothorax. Theunderlying lung is totally collapsed. The mediastinum isshifted to the contralateral side, compromising the functionof the opposite lung, and the high intrathoracic pressureelevates the jugular venous pressure, reduces venousreturn and causes tachycardia, low cardiac output, andeventually circulatory collapse and death.