Question

Doctor, you have a very unusual patient that has both nephrogenic diabetes insipidus and nephrotic syndrome. First, describe how this patient would appear (present) in your clinic. Second, describe the tests that you would order to confirm each of these diseases. Third, what is the course of treatment and medication that you would order for this patient.

Answer 1

1 presenting complaints

the patient may appear to the op department withpresenting complaints of edema around eyes and ankles, fatigue,loss of apetite and excessive thirst and excessive urination.

2 investigation

blood and urine examination should be done inorder to diagnose the disease

urine protein measurment, urine sediment examination , serum albumin are examined.

in case of nephrotic syndrome there will be proteinuria, hypoalbuminemia, hyperlipidemia

in case of diabetes insipidus bllod test helps to assess the level of ADH , and bllod and urine should be tested for glucose.

fluid deprivation test is also done in case of diabetes insipidus to understand whether the patient has the disease or if it is due to some other causes of polydypsia .

3 treatment :

diabetes insipidus -low salt, low protein intake may reduce urine output.

NSAIDS can be given - these drugs enhance urine concentration and also has some antidiuretic effect.

hydrochlorothiazide can be given as this increases salt and water uptake in PCT

nephrotic syndrome-blood pressure medications like ACE Inhibitors help to reduce the amount of protein released through urine.

statins- to treat hyperlipidemia and steroids are given

dietwith no salt will help to reduce fluid overload