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Renal Disease; Fluid and Electrolyte Disorders
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
This involves treatment of the underlying glomerular disease. Blood pressure should be controlled and diuretics can improve the oedema. Renal replacement therapy may be necessary if the renal impairment is severe. Antibiotics are given in postinfective glomerulonephritis to ensure that the infection is eradicated.
Arteropathies, Microcirculation and Vasculitis
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Lymphoedema is a chronic and progressive condition that can affect any limb or part of the body and is primarily due to reduced lymphatic transport. The condition can be primary (intrinsic developments), such as lymphatic development, or secondary (extrinsic factors), such as trauma. The oedema leads to a higher risk of infections, such as cellulitis. One of the first genes to be identified as causative agent for the development of lymphoedema was the mutated gene VEGFR3 (vascular endothelial growth factor receptor 3). VEGFR3 mediates lymphangiogenesis in response to growth factors C and D. This mutated autosomal dominant gene is found in Milroy's disease which includes oedema in the feet and lower limbs with hydrocele development in one third of males affected by the condition. Milroy's disease is a rare congenital disease which shows gross and diffuse dilatation of the lymphatics. Other mutated genes include PIEZO1 which is an autosomal recessive gene responsible for generalized lymphatic dysplasia (GLD). This is a very rare disorder, characterized by multifocal lymphatic malformations in various tissues, that is due to congenital abnormalities of lymphatic development. This has both internal, such as intestinal, and external, such as limb, oedema. Hennekam lymphangiectesia-lymphoedema syndrome (HS) has full body oedema, caused by mutations in CCBE1 and FAT4 genes.
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Relapses (three consecutive days of 2+ or more proteinuria on Albustix®), which occur in 70–80% of children, are generally detected through routine urinalysis performed by the parents or older child at home. This allows the early commencement of treatment prior to the development of generalised oedema with its attendant complications. Treatment of relapses consists of predniso(lo)ne 60 mg/m2 (maximum dose 80 mg) daily until urinary remission, followed by 40 mg/m2 (maximum dose 60 mg) on alternate days for 14 doses over a 28 day period. Intensification of relapse therapy has not been shown to be of long-term clinical benefit [6].
Diagnosis of Optic Disc Oedema: Fundus Features, Ocular Imaging Findings, and Artificial Intelligence
Published in Neuro-Ophthalmology, 2023
Walid Bouthour, Valérie Biousse, Nancy J. Newman
Prolonged severe optic disc swelling results in permanent and irreversible ganglion cell damage, adding to the underlying primary ischaemic, inflammatory, toxic/metabolic, or compressive insult to optic nerve fibres and resulting in deterioration of vision. Despite our evolving understanding of the pathophysiology of optic disc oedema from different mechanisms, accurate diagnostic criteria and classification scales of optic disc oedema still require refinement. There remains significant overlap among underlying mechanisms and current diagnostic criteria are non-specific and insufficient to precisely identify the underlying cause of the oedema. The development of multimodal ocular fundus imaging has enabled better appreciation of the structural anatomy of the optic disc and quantification of swelling on a continuous scale, thus allowing for more reliable follow up. Despite these advances, many aetiologies remain indistinguishable, especially in the acute stages.
Prevalence of severe acute malnutrition and its effect on under-five mortality at a regional hospital in South Africa
Published in South African Journal of Clinical Nutrition, 2022
Nosiphiwo Mandla, Cheryl Mackay, Siyazi Mda
Anaemia, diarrhoea and lower respiratory tract infections were highly prevalent co-morbidities in the study participants. This is in keeping with several other studies that report these conditions as common co-morbidities in patients with SAM.23,24 Our study found prolonged hospital stays associated with SAM, specifically in patients with HIV, nutritional oedema, sepsis and tuberculosis. Other studies report treatment at a hospital stabilisation centre, inpatient complications and persistence of oedema for more than four days to be predictors of longer recovery time.5 Prolonged hospital stays contribute to morbidity (possibly due to exposure to hospital pathogens), place socioeconomic strain on the community as parents are away from their work and families, and increase the burden on the health system related to intensive multidisciplinary care and overcrowding in hospital wards.
Severe lower limb lymphoedema successfully treated with a two-stage debulking procedure: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Adam Hague, Thomas Bragg, Melanie Thomas, Cheryl Pike, Karen Morgan, Amar Ghattaura
Lymphoedema is a chronic progressive disorder affecting up to 250 million people worldwide [1]. It is characterised by the impaired return of lymphatic fluid from the extremities resulting in oedema of the affected tissues. It can broadly be categorised into primary and secondary lymphoedema. Primary lymphoedema is caused by an inherent dysfunction in the lymphatic system whilst secondary lymphoedema results following an insult such as surgery, trauma or infection [2]. Filiriasis, a parasitic roundworm, is the leading cause of secondary lymphoedema worldwide, however, this is primarily limited to developing countries. In the developed world, the leading cause of lymphoedema is from cancer treatments including lymph node clearance [3,4]. The chronic deposition of protein-rich lymphatic fluid in the interstitial space stimulates an inflammatory reaction leading to fibrosis and further damage to the lymphatics with a resultant cycle of deterioration [5–7]. This ultimately results in a grossly enlarged extremity with increased susceptibility to infection, impairment of mobility/function and psychosocial morbidity [8–10]. Treatment therefore aims to reduce the swelling and its associated sequelae and thus improve quality of life. Various different treatment modalities exist ranging from compression garments, exercise, skin care and manual lymphatic drainage to surgical interventions.