Frusemide 1g/day may be needed to produce naturesis and reduce oedema. If diuresis is too vigorous, it may precipitate circulatory collapse and acute

insignificant. (b) Diuretics - Frusemide 1g/day may be needed to produce naturesis and reduce oedema. If diuresis is too vigorous, it may precipitate circulatory collapse and acute renal failure. The possibility can be anticipitated by infusion of 'salt-poor1 albumin to maintain plasma volume. (c) Hypehipidemia - There is increased incidence of cardio-vascular disease when proteinuria is heavy and prolonged Hydroxymethyl glutaryl co-enzyme A (HMG CoA) reductase inhibitors may be helpful. (d) Antibiotics - Prophylactic antibiotics should be given against possible pneumococcal peritonitis andsepticemia MANAGEMENT OF RFLAPSE - Relapses may be associated with bacterial or viral infection especially of upper respiratory tract. Treatment consists of - (a) Corticosteroids - for infrequent relapses and if the disease remains sensitive to steroid therapy. The drug may be given as a continuous low dosage regime, each patient should be 'titrated' for the lowest effective dose (usually 5-15 mg/day). This may eliminate the need for giving ACTH, or alternate day steroid schedule to prevent the most important side effect of steroids in children namely growth failure. (b) Cytotoxic drugs - in those who suffer frequent relapses Cyclophosphamide 1.5-2.5 mg/kg/day for 8 weeks induces stable remission averaging about 3 years. Leucocyte count should be checked weekly. Immediate toxicity of the drug is negligible but there may be long-term effects. II. With diffuse membranous glomerulonephritis -Long term outlook is poor. Prednisolone 120 mg on alternate days may result in improved renal function Dipyridamole, warfarin and cyclophosphamide may also produce significant fall in urine protein, rise in serum albumin and improvement in creatinine clearance. 5. RECURRENT HEMATURIA - yndrome dominated by episodes of macroscopic hematuria, at times associated with loin pain and with tendency to exacerbations following viral upper respiratory infections or strenuous exercise. It most commonly affects boys and young males. Microscopic hematuria persists inbetween attacks and protenuria absent or moderate. Renal pathology in most cases is IgA nephropathy (Berger's disease) Course is often benign, some patients tend to develop progressive renal disease Treatment - None specific. 6. PERSISTENT ASYMPTOMATIC PROTEINURIA AND/OR HEMATURIA - in an apparently healthy person is detected on routine medical examination Causes - (a) Primary glomerulardisease - Mesangial proliferative GN, mesangiocapillary GN, membranous GN, focal segmental glomerulosclerosis (b) Multisystem disease - SLE, Henoch-Schonlein purpura (c) Miscellaneous - (i) Renal - Tumors, cystic disease of kidney, renal tuberculosis, tubointerstitial nephropathy. (ii) Non-renal - Urothelial tumors, prostatic disease Investigations -Assessment of renal structure and function including urine microscopy and culture, IVU and ultrasound. Renal biopsy if evidence of disease progression, particular/ if the process is amenable to therapy. 7. HYPERTENSION - Incidence of hypertension in patients with renal disease rises as renal function declines. Two major mechanisms are responsible. (a) Raised BP as a result of renal or renal vascular disease - (i) Increase in body sodium and water content. (ii) Inappropriately increased activity of the renin-angiotensin aldosterone system. (b) Renal damage as consequence of raised BP- The effect of hypertension depends on whether the raised pressure is in the benign phase or accelerated phase. In the latter, rapid progression to renal failure is the rule. 4. ACUTE RENAL FAILURE (ARF) Definition - ARF may be defined as an sudden fall in glomerular filtration rate sufficient to cause uremia. Oliguria (<>