Urinary Tract Anomalies And Infections In Children Ecab

Urinary tract disorders, be they anomalies or infections, are an important cause of acute and long-term morbidity in children. These conditions need prompt diagnosis and management, not only to relieve the acute morbidity, but also to prevent the long-term renal damage. This makes diagnostic and therapeutic issues concerning these conditions very important. The most common urinary problem encountered in children is urinary tract infection (UTI), which is usually bacterial in origin. Urinalysis and culture play an important role in the diagnosis of this condition. The treatment consists of prompt and specific antibiotic therapy followed by genitourinary imaging in high risk patients to detect underlying urinary tract anomalies. Vesicoureteric reflux (VUR) is characterized by retrograde flow of urine from the bladder to the kidneys, thereby predisposing it to UTI, and the two conditions together are believed to be associated with renal nephropathy. Patients with VUR have an increased risk of developing hypertension, toxemia of pregnancy, and significant renal damage, including end-stage renal disease subsequently in life. Based on the current literature, the author has enumerated various treatment options available for the different grades of VUR. The urinary bladder is meant to function as a storage organ for urine that empties completely in an appropriate time and place. Any disorder that results involuntary passage of urine or inability to void to completion constitutes bladder dysfunction. Bladder dysfunction is increasingly recognized as a risk factor for UTI and VUR, and a cause for enuresis with daytime symptoms. Its diagnosis requires detailed clinical history and examination, non-invasive urodynamic tests, frequency volume charts, and abdominal ultrasonography to predict the type of bladder dysfunction. The author has emphasized on the importance of multidisciplinary approach in its management, comprising of medications, treatment of any underlying cause, scheduled voiding regimen, clean intermittent catheterization, positive reinforcement and where necessary, biofeedback strategies. The book also contains a chapter on the management and long-term outcome of common kidney and urinary tract anomalies detected on antenatal screening such as unilateral or bilateral hydronephrosis, multicystic dysplastic kidneys, and posterior urethral valves.

With the increase in lifestyle-related diseases like diabetes and hypertension the prevalence of Chronic Kidney Disease (CKD) is increasing exponentially and with it is increasing the burden of its ominous consequence, End Stage Renal Disease (ESRD). While ESRD is no longer a death sentence with the advent of efficient renal replacement therapies and the success of renal transplantation, factors such as high cost of these procedures, limited availability of donated kidneys and not enough number of centers equipped with these facilities puts the effective management of ESRD beyond the reach of an average person many-a-times. Additionally the presence of co-existing diseases that contribute to and sometimes complicate the renal impairment as well as delayed referral of the patients to nephrologists also makes matters worse. ESRD is not just a medical but also a social and economic condition that devastates the person and his/her entire family. Hence, early detection and effective prevention of progression of CKD in early stages to advanced CKD and ESRD is the call of the day. In fact, understanding the pathophysiology of the condition and adopting methods of primordial prevention in populations at risk may be desirable to ensure reduction in the incidence of CKD. In those with established CKD, a proactive approach to manage the disease manifestations and limit the ravages of other comorbidities is desirable. For those in advanced stages of CKD, the institution of an appropriate renal replacement therapy individually suited to the patient keeping in view the medical status, lifestyle requirements, economic viability and social acceptability should be advised. This book will help the reader understand the intricacies of the aspects mentioned above and guide the practitioner to diagnose and manage End Stage Renal Disease with special reference to practical experience of the same in India. The authors have put together the most relevant facts about the disease for an easy comprehension and understanding of the same by practitioners and students across the specialty.

The skeleton is a metabolically active organ that undergoes continuous remodeling throughout life. This remodeling is necessary both to maintain the structural integrity of the skeleton and to fulfill its metabolic functions as a storehouse of calcium and phosphorus. Skeletal remodeling can be triggered by changes in mechanical forces or microdamage and by hormonal response to changes in circulating calcium and phosphorus levels. The skeleton also serves as the second line of defense against acidosis, and it is able to liberate buffers in the form of inorganic phosphates. Disorders of Bone and Mineral Metabolism is a multi-authored clinical update that covers all major aspects of bone and its mineral disorders. The first chapter is divided into different sections describing various minerals of clinical importance followed by regulation of mineral metabolism by parathyroid hormone, and vitamin D. There is a very good balance of basic information to act as a primer for the reader and the supporting experimental evidence. The complicated and often difficult topics of mineralization of bone and its regulation and other aspects of mineral metabolism are presented in a particularly clear and interesting manner. A long and useful bibliography follows every chapter. This update contains thorough discussions of the pathophysiology, diagnostic techniques, and therapy of mineral diseases with a wealth of detail. The book is a very useful reference for those interested in bone and mineral physiology and disease, be it a general physician or a nephrologist.

Perinatal medicine encompasses various current topics in fetal diagnosis and management, besides preconception counseling. The concept of preconception counseling and healthcare evaluation optimizes a couple’s readiness for childbearing. This helps to minimize any foreseeable adverse factors through a careful diagnostic review and provision of appropriate intervention and therapy in advance. This has been dealt with in detail. The section on etiology and management aspects of Intrauterine Growth Retardation (IUGR) covers investigation and management of suspected or known fetal abnormalities, placental failure, and fetal growth retardation. Prenatal diagnostic procedures had limited access and safety so far, but this is a thing of the past today, especially after the advent of real-time ultrasonography. It brings an increasingly clearer visualization of the intrauterine space and has vastly broadened the scope for fetal diagnosis and treatment. The currently available ultrasound-guided procedures for fetal diagnosis and therapy are discussed at length in the chapter invasive ultrasound procedures. The discussed invasive ultrasound procedures include amniocentesis, cordocentesis, and chorionic villus sampling, done to detect neural tube defects, fetal lung maturity, and chromosomal abnormalities. The controversies surrounding the evaluation of fetal anomalies by ultrasound procedures are covered at length which we expect would be of special interest to the readers. Opinions abound as well as differ on the interpretation of the findings and counseling of couples, based on the same. This section focuses on the implications of missed fetal anomalies in this background and its impact on pregnancy outcome.

Acute pancreatitis is defined as an acute inflammatory process of the pancreas that may also involve peripancreatic tissues and/or remote organ systems. It typically presents with sudden deep, boring pain that starts in the epigastrium and radiates to the back, which usually worsens on intake of food. It may be of varying severity ranging from mild to severe. Mild disease, if managed promptly and adequately resolves with minimal or no sequelae and seldom leads to extended morbidity or mortality. However Severe Acute Pancreatitis has a longer course of resolution, usually requires hospitalization and has a greater propensity to lead to adverse outcomes. As a thumb rule, it has greater morbidity and mortality rates as compared to Mild Acute Pancreatitis. Understandably, the management protocol for the severe acute pancreatitis is more invasive and emergent, and may require intensive care management. Hence understanding and assessment of the condition in the first 48 hours is a critical step in deciding the outcome. The various assessment criteria that are used to prognosticate and plan the management for this disease have been discussed in this clinical update. Previously, the condition was thought to be caused by infection, but now it is an established fact that it is an acute inflammation of the pancreatic gland with activation of the pancreatic enzymes within the gland leading to its autodigestion. Previously, acute pancreatitis was considered to be mostly associated with chronic alcohol abuse or acute bouts of binge drinking. With the availability of data from recent studies in India and the Asian subcontinent, Biliary disease is emerging as the commonest etiological agent. Extensive genetic analysis and mapping have helped put a cause to the erstwhile "idiopathic" cases. Newer diagnostic modalities and minimal invasive procedures have made the conventional surgeries nearly obsolete now. The rationale and use of antimicrobial treatment in the medical management of the condition has also undergone a change. This clinical update has been designed to update the readers on the important aspects of Acute Pancreatitis. The book has stressed upon various aspects of the condition like the etiology, pathogenesis, diagnosis and evaluation along with an insight into the management approach of the patient including the supportive and nutritional management. Overall, the book presents to the readers an excellent compilation of clinically applicable literature sourced from the most acclaimed physicians in the country.

This book discusses the epidemiology, recognition, screening, and management of the various common systemic diseases that commonly present with renal manifestations like diabetic nephropathy, lupus nephritis, hypertension and renal involvement, liver disease, and dysproteinemias. Diabetic nephropathy remains the leading cause of end-stage renal disease across the world. The outlook for patients who have lupus nephritis has improved in the last decade. Kidney disease is common in patients who have advanced liver disease, and creatinine-based methods do not provide an accurate estimation of renal function in this population. Dysproteinemias are associated with protean renal manifestations, and renal disease may be the presenting manifestation. The authors have given a very comprehensive view pertaining to each topic and have given an insight to their own clinical experiences along with the standard guidelines as followed.