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A COMPLICATED CASE OF KWASHIORKAR+ NEPHRITIS

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 9 replies. You can also reply via email – be sure to leave the subject unchanged.

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Kiran Deshpande Shukla

Normal user

2 Mar 2012, 06:01

IN OUR FACILITY BASED MANAGEMENT CENTER, WE HAD A FEMALE CHILD WHO WAS DIAGNOSED AS KWASHIORKAR. SHE HAD BILATERAL PITTING EDEMA. HER EDEMA REDUCED GRADUALLY BUT REAPPEARED SOON. SHE WAS THOUGHT TO HAVE A RELAPSE.HOWEVER, SHE WAS DIAGNOSED WITH NEPHRITIS. [THERE WAS CAST PRESENT IN HER URINE ANALYSIS AND ACCORDING TO THE DOCTORS, THE SERIES IN WHICH HER EDEMA HAD REAPPEARED SUGGESTED POSSIBILITY OF RENAL INVOLVEMENT]

I WOULD LIKE TO KNOW-
1.COULD HER INITIAL DIAGNOSIS HAVE BEEN WRONG?
2. COULD HER DIAGNOSIS OF `NEPHRITITS` HAVE BEEN WRONG?
3. IS SUCH A `OVERLAP` POSSIBLE?
4. ASSUMING THAT BOTH WERE CORRECT, WHAT SHOULD BE THE NUTRITIONAL MANAGEMENT OF SUCH A CHILD?
5. HOW TO DIFFRENTIATE BETWWEN EDEMA OF RENAL INVOLVEMENT AND NUTRITIONAL EDEMA?

Phindile Chitsulo

Normal user

2 Mar 2012, 09:38

Dera Kiran,
We usaully experience the same in our Community Based Management of Acute Malnutrition programme in Malawi, where sometimes service providers confuse Nephrotic Oedema and Nutrition Oedema.
I am assuming there would be possibilities of an overlap, however, there should be caution taken when managing that situation, so that the treatment of one should not worsen the other.

In order to diffrentiate the two, note that Nutrition Oedema is usually characterised by pitting where a dent is formed following 3 seconds thumb pressure and I expect Renal Oedema not to pit.

Kiran Deshpande Shukla

Normal user

3 Mar 2012, 03:52

but how shd the nutritional management go in such a case?? also, what causes the pitting in nutritional edema???

Abdullahi Mohamed Ibrahim

CTC Head Nurse

Normal user

3 Mar 2012, 08:01

Dear kiran

Though these cases are very rare,i think you did management of such case,in your exprience how did you treat this case ? and also what is your advice to wards like this case.

Anonymous 621

Normal user

3 Mar 2012, 09:39

Has the possibility of Post Streptoccocal GlomeruloNephritis, been investigated, which may need a public health intervention as well to reduce the spread.
Children with PSGN have hypertension, haematuria, proteinuria, oliguria, oedema. The fluid restriction during initial nutritional treatment (if she was on F75) treatment may have reduced the swelling and once completed the oedema return. Just a possibility!

Kiran Deshpande Shukla

Normal user

8 Mar 2012, 15:21

dear all,

it seems ,after all, she was just a case of kwashiorkar! no renal involvement could be confirmed

Anonymous 706

Normal user

13 Mar 2012, 11:44

I don´t think renal oedema is a non pitting one, so, in my opinion, it is not useful to distinguish between nutritional and renal oedema.

Bheru Lal

Nutrition Programme Manager

Normal user

1 Apr 2012, 10:15

we have experienced nutritionist on same page so we can get better answer. can any one distinguish the nutritional and nephritic edema? if both are present in any one case then how we will identify ? if yes , then what should be our next step?\

Thanks in advance for your response..
cheers.................

Chrisy Banda

Normal user

3 Apr 2012, 20:36

to distinguish the nutritional and nephritic edema for an individual to know that this is nutritional edema it has to be through assessment of the child and it is by assessing the using the thumbs pressed on the feet of the child if the edema is pitting and presents in both feet and it starts from the feet when the condition deteriorates it increases to legs face. while for for nephritic edema it is not pitting usually does not start from the feet .

if both are present in order to come up with a clear clinical picture on that one you have to include clinical assessment that include medical history & physical examination that will help to rule out other medical conditions and to come up with the right diagnosis.
if yes then the child will be treated as having both conditions hence will be treated for both that is for nephritic and nutritional edema

Kiran Deshpande Shukla

Normal user

22 Apr 2012, 03:58

where does the nephritic edema begin?? if it begins at some other site than legs,is it safe to assume that it is nutritional edema??

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