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Jul07
Child Kidney Specialist in Delhi - Dr. Sidharth Kumar sethi
Healthy Kidneys For Healthy Kids

Better kidney health for kids: What you should know!
Did you know that kidney diseases can start young? Literally. Unlike in the case of grown-ups, children can develop kidney diseases due to congenital defect, prematurity, or past hospitalization. "Also, children with a high-risk birth and early childhood history should be watched closely in order to help detect early signs of kidney disease in time to provide effective prevention or treatment. Needless to say that the sooner the issue is diagnosed, better can be the results," adds Dr Sidharth Kumar Sethi, Consultant, Pediatric Nephrology, Medanta, The Medicity, Gurgaon.

Early signs of kidney disease in kids
Early diagnose of kidney problem can help treat the ailment in time. Here are some signs that you should watch out for:

- Swelling around the eyes-face -feet- abdomen- whole body - Bed wetting (5 years or older) can be since birth or if the problem recurs after the child had stopped bed wetting for some time -Frequent urination - Crying during urination (in infants) - Painful urination (in older kids) - Unpleasant-smelling urine -Unexplained low-grade fever or recurrent fever episodes - Urine that is cloudy, bloody or dark brown - Persistent abdominal pain - Childhood renal stones - Frequent severe headaches - High blood pressure - Producing less urine -Producing more than 2 litre urine/ day -Poor appetite (in older children) - Poor eating habits, vomiting (in newborns & infants) - Slow growth or weight gain -Weak urinary stream, dribbling of urine stream - Weakness, excessive tiredness or loss of energy - Pale skin appearance

Protection plan
Have lots of water: To keep kidneys healthy, kids should stay hydrated- mostly by drinking water. Their pee should be pale in color, and they should drink more than usual when exercising especially under a hot sun. Kids should avoid nutrient-spiked drinks. Enough water is still the best and safest bet to meet their fluid needs.

Avoid sports drinks and processed: Today's diets are so extreme and unhealthy. Vitamin waters, sports or energy drinks, processed 'super-foods' are not nutritious and add to the risk of obesity in children.

Avoid too much protein: Protein intake should be in adequate amount. It is advisable to not make your kids indulge in too much protein.

Excess salt is bad: Too much sodium (in junk food, burgers, chips and street food) can contribute to high blood pressure. Eating more whole foods, choosing fewer processed foods- emphasizing those with made without added salt or sauce can help lower sodium intake. Cooking more at home can also help families slash sodium. Cut back on table salt and salty snacks.

Regular exercise: Increasing physical activity not only helps to reduce blood pressure, but it can help a child who is overweight reach and maintain a healthy weight. Sports and exercise programs at school may be good ways to increase the child's activity level.

Who should be screened?
Following children should be screened by a specialist for blood and urine test; growth and blood pressure:

Family history of kidney disease
Children born early or small-for-date
Obese children; or those not growing well
Abnormal antenatal ultrasound
History of urine infection
Abnormal urine examination
It is also extremely important for the health community to encourage pregnant females to undergo antenatal ultasonography. With the growing cases of kidney issues in children, it is crucial that we encourage and facilitate education, early detection and a healthy life style in children, starting at birth and continuing through to old age, to combat the increase of preventable kidney damage and to treat children early.


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Jul07
Expertise - Pediatric Nephrotic syndrome, Renal dysplasia, Chronic Kidney disease, Neurogenic bladder - Pediatricnephrologyindia
Dr. Sethi at Medanta, The Medicity is the leading Pediatric Nephrologist providing diagnostic and treatment services for children with conditions of the kidney especially Nephrotic syndrome, Glomerular disorders, rare tubular disorders and Chronic Kidney disease. Our team is the leading dialysis and renal transplant service centre for children. Dr. Sethi & team believes in personalized care that focuses on individual patient and family needs. Our team understands the challenges many of our families face when trying to access the care they need. Our caring goes beyond diagnostics and treatment. Our team is nationally recognized for their innovation, experience, dedication and expertise. We have the newest dialysis technology inpatient and outpatient, and provides comprehensive kidney transplant care to children of all ages.

Dr. Sethi leads in care of children with the following disorders:
Pediatric Nephrotic syndrome
Complex recurrent urinary tract disorders
Glomerular disorders
Blood or protein in the urine
Glomerulonephritis
Hemolytic uremic syndrome
Hydronephrosis
Hypertension
Rare tubular disorders
Polycystic kidney diseases
Neurogenic bladder
Renal dysplasia
Renal tubular acidosis
Systemic lupus erythematosus
Vesicoureteral reflux
Acute Kidney Injury
Chronic Kidney disease
Kidney Transplantation- Blood group compatible and incompatible; transplantation in complex renal anomalies


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Jul07
Nephrotic syndrome Specialist in India - Dr. Sidharth Kumar Sethi
Nephrotic Syndrome

Most people have two kidneys, one on either side of the body just beneath the ribcage. Healthy kidneys filter the blood and allow small particles of waste products and water to be excreted as urine. Kidneys also play important role in the control of blood pressure, maintenance of bone health and formation of red blood cells.

What is nephrotic syndrome?
Nephrotic syndrome occurs when the kidneys leak large amounts of protein (especially albumin) into the urine. It is these proteins which is mainly responsible for holding water in the blood vessels, and when they are lost in urine, their level decreases in the blood which causes the water to come out of the blood vessels and cause swelling (edema).

What causes Nephrotic Syndrome?
In most cases, the exact cause of nephrotic syndrome is not known. There is no relationship with diet or socioeconomic status of the family. It is non-infectious and does not transfer to other family members

What are the symptoms?
The most common symptom is swelling (edema). It first appears on the face, especially around the eyes which is most prominent in the morning when the child gets up and decreases by the evening.

Other symptoms include: Frothy urine, weakness and tiredness, passing less urine than usual, recurrent infections, diarrhoea.

What is the treatment?
Prednisolone (steroid) is the drug of choice when the child is first diagnosed. Most children respond to this drug with disappearance of the protein in the urine and loss of swelling within 1-2 weeks (we call this REMISSION). Other drugs like diuretics, ACE inhibitors, etc may be required for symptomatic treatment.

Those who do not respond to steroids are given second line drugs like Cyclophosphamide, MMF, Levamisole and other immunomodulators as decided by your doctor according to the individual patient profile.

Duration of treatment: First episode is treated for 3 months and subsequent episodes are treated as decided by your physician.

What are the side effects of the treatment?
Common Side Effects of Steroids are:

Decreased resistance to infections such as cough and cold
Increase in appetite
Flushed, swollen cheeks and stretch marks on the skin
Rise in blood pressure
Behavioral problems e.g temper tantrums, or mood changes.
However most of the side effects are reversible and wean off once the steroid is stopped.

Long term supervision and course of nephrotic syndrome
In most cases the child with nephrotic syndrome becomes completely well with prednisolone treatment, and there are very few who require second line treatment which includes immunomodulators and other drugs.

The child may remain well for several months or longer. During this period, the child should be regarded as being normal, and should not be made to feel different from other children.

In majority of cases, however, nephrotic syndrome recurs. The recurrence is indicated by appearance of swelling around the eyes, which, if untreated, gradually increases to involve the face, feet, legs and abdomen, and in such conditions, doctor should be consulted immediately. Relapses are common in early childhood but decrease with age.

More than 90% of children with nephrotic syndrome go into adulthood with their kidneys functioning normally.

What are parents expected to do at home?
Starting and stopping of medicines should be strictly done as advised by the doctor.
Daily urine protein monitoring by urine dipsticks till negative for three days then atleast thrice a week during remission.
Keep a diary of all urine results so that your doctor can review your child’s progress in clinic. The dose of Prednisolone and any other medications and other comments should also be recorded.
In remission phase immediately report to the doctor under following conditions:
Swelling around the eyes
Decreased urine output
Urine protein 1+ or more for persistent 2-3 days
Any sign of infection like cough, cold, coryza.

Dietary advice for your child:
The child should be given a diet with enough proteins. High protein food items include milk and milk products, dal, chana, soyabean, eggs, meat and fish.

If the child is edematous, the doctor might advise salt restriction. Once the swelling disappears, the child can have his usual diet. It must be understood that salt has no role in the causation of nephrotic syndrome. No benefit can be expected by prolonged restriction of salt unless advised by the doctor for some other reason (e.g., if the blood pressure is high).

When is kidney biopsy required?
Very few children require kidney biopsy. Certain conditions in which children do not respond to daily treatment or have persistent gross hematuria, persistent hypertension, low complement level (C3 / C4) require kidney biopsy.

What immunizations are necessary?
Children who are on steroid medications and other immunosuprressives can become very unwell if exposed to CHICKENPOX or MEASLES, therefore they should be immunized for the same and also receive pneumococcal vaccine.


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Jun30
Best Pediatric Nephrologist And Child Kidney Specialist in Delhi, Gurgaon, India - Dr. Sidharth Kumar Sethi
Dr. Sidharth Kumar Sethi
Kidney & Urology Institute

He was trained as a Fellow (International Pediatric Nephrology Association Fellowship) and Senior Resident in Pediatric Nephrology at All India Institute of Medical Sciences and Division of Pediatric Nephrology and Transplant Immunology, Cedars Sinai Medical Centre, Los Angeles, California. He has been actively involved in the care of children with all kinds of complex renal disorders, including nephrotic syndrome, tubular disorders, urinary tract infections, hypertension, chronic kidney disease, and renal transplantation. He has been a part of 8-member writing committee for the guidelines of Steroid Sensitive Nephrotic Syndrome and Expert committee involved in the formulation of guidelines of Pediatric Renal Disorders including Steroid Resistant Nephrotic Syndrome and urinary tract infections. He has more than 30 indexed publications in Pediatric Nephrology and chapters in reputed textbooks including Essential Pediatrics (Editors O.P. Ghai) and “Pediatric Nephrology” (Editors A Bagga, RN Srivastava). He is a part of Editorial Board of “World Journal of Nephrology” and “eAJKD- Web version of American Journal of Kidney Diseases”. He is a reviewer for Pediatric Nephrology related content for various Pediatric and Nephrology journals.


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Apr28
Gallstone Ileus
Gallstone ileus is obstruction of the bowel due to impaction of one of more gallstones. To achieve this, stones usually have to be at least 2.5 cm in diameter.
A fistula develops between a gangrenous gallbladder and the duodenum or other parts of the gastrointestinal tract, allowing passage of the stone. Occasionally the stone may enter the intestine through a fistulous communication between the bile duct and the gastrointestinal tract. Stones less than 2.5 cm in diameter may traverse the alimentary canal without causing obstruction. When the gallstone lodges in the duodenum and causes gastric outlet obstruction, it is called Bouveret's syndrome.
Read more : - http://drbcshah.com/gallstone-ileus/


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Jan27
Sebaceous Cyst Removal
Sebaceous cysts (epidermal cysts) may be a foreign term to you, but many women have indeed experienced them perhaps without really knowing what they were at the time.
Sebaceous cysts are small lumps or bumps just under the skin. To be more specific, they are closed sacs that contain keratin a "pasty" or "cheesy" looking protein that often has a foul odor.
Although they are usually found on the face, neck, and trunk, they also occur in the vaginal area or other parts of the genitalia. In cases of the latter, it is not uncommon for women to fear that they are the result of genital herpes. But genital herpes create a blister-type sore that eventually becomes crusty, not just a bump or lump under the skin.

What Causes Sebaceous Cysts?
Sebaceous cysts are often the result of swollen hair follicles or skin trauma.

Symptoms and Signs/Symptoms of Infection

Sebaceous cysts are usually painless, slow-growing, small bumps or lumps that move freely under the skin. It's important not to touch or try to remove the substance inside to prevent tenderness, swelling, and infection of a sebaceous cyst.
Occasionally, infections may occur. Signs or symptoms that may indicate infection of sebaceous cysts include:
Redness
Tenderness
Increased temperature of the skin over the bumps or lumps
Greyish white, cheesy, foul-smelling material draining from the bump or lump

How Are Sebaceous Cysts Diagnosed ?

Sebaceous cysts, to the trained eye, are usually easily diagnosed by their appearance. In some cases, a biopsy may be necessary to rule out other conditions with a similar appearance. You should see your doctor to get a formal diagnosis if you suspect that you have a sebaceous cyst.

Treatments for Sebaceous Cysts

Sebaceous cysts most often disappear on their own and are not dangerous. As stated, however, they may become inflamed and tender. Sometimes sebaceous cysts grow large enough that they may interfere with your everyday life. When this happens, surgical removal may be necessary, and this procedure can be done at your doctor's office. Small inflamed cysts can often be treated with an injection of steroid medications or with antibiotics.

Complications of Sebaceous Cysts

If sebaceous cysts become infected, they can form into painful abscesses.
The surgical removal of a sebaceous cyst that does not involve the excision of the entire sac may cause the cyst to come back (although, recurrence is not usual).
Remember to consult Dr. B C Shah anytime you notice any type of growth, bump, or lump on your body. Although sebaceous cysts are not dangerous, your doctor should examine you to ensure that another more dangerous concern is not present.

- See more at: http://drbcshah.com/sebaceous-cyst-removal/#sthash.FpyyRl4g.dpuf


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Jan22
Colonoscopy
A colonoscopy is an internal examination of the colon (large intestine) and rectum, using an instrument called a colonoscope.

The colonoscope has a small camera attached to a flexible tube that can reach and examine the entire length of the colon.

How the Test is Performed

You will usually be given medicine into a vein to help you relax and not feel any discomfort. You will be awake during the test and may even be able to speak, but you will likely not remember anything.

You will lie on your left side with your knees drawn up toward your chest. The colonoscope is inserted through the anus. It is gently moved into the beginning of the large bowel and slowly moved as far as the lowest part of the small intestine.

Air will be inserted through the scope to provide a better view. Suction may be used to remove fluid or stool.

Because Dr. B C Shah gets a better view as the colonoscope is pulled back out, a more careful examination is done while the scope is being pulled out. Tissue samples may be taken with tiny biopsy forceps inserted through the scope. Polyps may be removed with snares, and photographs may be taken.

Specialized procedures, such as laser therapy, may also be done.

See more at: http://drbcshah.com/colonoscopy/


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Jan18
512 stones found in Gall bladder
(Dr. B C Shah recently performed Laparoscopic Cholecystectomy on Mr. N_____ G______ who had 512 stones!)

Mr. N_____ G______ came to me with history of chronic pain in upper abdomen. The pain would get aggravated after meals. His sonography revealed that his gall bladder was distended & full of stones. I performed Laparoscopic Cholecystectomy on him. It was a difficult case as there were lot of adhesions. The gall bladder was delivered successfully It was a pleasant surprise to find 512 stones in the Gall Bladder.

One often wonders as to why patients wait so long. Many times patients come to me with Gall Stones. Often they have only one small stone. The common question asked is "Do I still need surgery for just a small stone?"

As per my observation of last 23 years, one stone or many stones all have a potential to create complications including even death. Its not just the numbers or size. One small stone can just simply slip into the bile duct and is sufficient to trigger Pancreatitis. I personally know of a patient who developed severe pancreatitis due to a 3 mm small stone. She battled for two months in one of the best hospitals in Mumbai and ultimately died.

In kidney stones, one of the criteria on which the therapy is based is the number of stones and its size. Smaller stones can pass out spontaneously and the patient's problem gets solved naturally. However, this is not the situation with gall stones. A gall stone or its fragment passing out can be dangerous as it can cause blockage of bile in liver or swelling in pancreas. Such complications can occur any time and no doctor on earth can predict when this will occur.

Many patients wait for the stones to grow and multiply. Surely this has a potential of inviting big untimely trouble. Don't wait. There are no warning signs.As far as records go, the largest number of gallstones removed was 3,110 in an open surgery in Britain in 1983, reported in the Guinness Book of World Records.

- See more at: http://drbcshah.com/512-stones-found-in-gall-bladder/


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Jan15
Intestinal Obstruction due to Stones
MRS R____ K____ , a 55 year old female was transferred from a local nursing home

She was admitted in a local Nursing home with abdominal pain & vomiting. She was treated as a case of acidity. In spite of the treatment for a week, she did not improve.

When she came to me, her symptoms were suggestive of intestinal obstruction (blockage). A CT scan of abdomen was undertaken. CT scan revealed that she had intestinal obstruction due to a large 5 centimeter stone. This is called Gall stone ileus.

How did the stone land up in her intestine?

No it was not a swallowed stone. This stone had formed in her Gall Bladder over many years. Due to its weight & chronic inflammation, the stone gradually perforated into her small intestine (duodenum). Since the stone was very large it could not pass thro the small intestine and got stuck in the last part of small intestine. Patient was having pain & constantly vomiting due to this blockage.

The treatment was done using minimal access surgery instead of making a big cut on her abdomen laparotomy. Using laparoscopy, the site of blockage was identified. A small incision was made on her abdomen. The stone was cut open from the intestine (enterolithotomy) and the intestine was placed back into the abdomen.

The blockage was cleared and the patient recovered smoothly and was discharged in few days.

See more at: http://drbcshah.com/intestinal-obstruction-due-to-stones/


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Jan13
Hernia Becomes Gangrenous
Often Indian ladies have large bellies. Common causes are multiple pregnancies, sedentary lifestyle, poor physical exercises and health neglect. At times scars on abdomen of surgeries compound the weakness of the tummy.

It is not uncommon to notice a protrusion (hernia) thro natural scar (umbilicus) or surgical scars. "My mom also had it" is a common answer which denotes that they have a metabolic error whereby the scars are inherently formed weak. They move around with such bulges on their huge tummies. At times there is no umbilicus visible because of huge hernias. At times they are huge protrusions of the intestines and other contents.

So when the patients are advised to get operated their argument is that so many have it and for so many years they are carrying on without any complaints, so why operate? Well the reason to get it operated is that slowly all of them grow. More and more contents of the tummy start protruding out and one day it becomes so tight or overcrowded that they get strangulated and there is no space for blood to nourish the intestines and other contents. Thus a simple problem gets complicated. The patient all of a sudden suffers from great pain as a result has to be rushed to the hospital. The surgery becomes lengthy and riskier. The recovery period increases and so does the cost. Why wait so long?

- See more at: http://drbcshah.com/hernia-becomes-gangrenous/


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