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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for nephrotic syndrome

Hello.
I'm here in Bali, Indonesia. My best friend was taken to a local hospital three days ago because he has edema all over his body (legs, belly, back, neck, face). Xray, ultrasound and blood test was done. Unfortunately the doctor doesn't want to explain to me what exactly is wrong with my friend. He just says: his kidneys are 'leaking', and something about infection...
He has prescribed him furosemide 40 mg, folic acid, calcium, captopril 25 mg twice daily. So far, his edema has not decreased, but rather got worse (Probably he should take a higher dose of furosemide?).
I have read a lot about this Nephrotic syndrome, and I have the feeling this doctor is just treating my friends symptoms and not the cause of his condition (maybe he doesn't know it?).
Today, the nurse said that my friend needs albumin infusions (which I've read are usually not that effective in this case - or at least don't have a long lasting effect).
The thing is: Albumin infusions are really expensive over here in Bali. My friend and his family are really poor and can't afford to buy a liter of albumin infusion...

A beg you for a little advice, because my friend looks really bad. And I think the doctor has little idea of what he's doing... (He only shows up once a day for about 1 Minute to see him, doesn't explain anything, and he said my friend can probably go home in 4 days - although nothing has changed so far!). I've yet to find a good doctor in my area. (Unfortunately there is only this one so called 'specialist' in this area!).

Do you have any advices? Anything I can do? I'm really desperate!
Sincerely yours
Ketut Sucra
Tue, 22 Aug 2017
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Nephrologist 's  Response
Can u pls make it clear the age of your friend and some reports..like Complete urine examination and 24 hour urine estimation.
We have to look into these two entities to label it as Nephrotic syndrome...
Once we have made this diagnosis ..it's just a syndrome ..many diseases present this way...so the next step is to find the cause of Nephrotic syndrome through renal biopsy.

Renal biopsy alone will help in making absolute diagnosis and help in specific management. of course diuretics may still be used , albumin infusion may be necessary even after that but making correct diagnosis like
MEMBRANOUS NEPHROPATHY , MCD , FSGS will help in prognosticating and starting of specific management options like steroids and immunosuppressants.

My advice is to have a consultation with nephrologists. Renal biopsy should be done if kidneys are of normal size.
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