Journey of a Drug: Design to Market Seller

Where do the medicines we take from chemists come from? How do the doctors know which drug is good for which disease? How the medicines really are able to cure a particular ailment they have been prescribed for? Do these questions come to your mind, whenever you buy any medicine?

Come, let us today know about the medicine development from the beginning

The development of medicine is called a Clinical Research and has different Phases. Phases of the clinical research are the steps of experiments with a health intervention in an attempt to find enough evidence for a process which the scientists think would be helpful in medical treatment.

The pharmaceutical study starts its journey from a drug design and drug molecule discovery which further progresses into animal testing and then human studies to see the drug’s effectiveness.

Drug undergoes many trials- Preclinical, Phase 0, Phase I, II, III and IV. Sometimes combined trials also are undertaken to reduce the time of development, like Phase I/II and II/III.

Pre-Clinical Study

When the drug molecule is identified, it undergoes many in vitro (test tube or cell culture) and in vivo (animal) experiments. These experiments are conducted to know the preliminary efficacy, toxicity, and pharmacokinetics of the various doses of the drug. Many drug molecules are designed at a time and these pre-clinical studies let the pharmaceutical companies decide which molecule has a greater potential in further studies.

Design of the Studies:

Trials are always conducted by following the set of steps, called the protocol, developed by the researchers to find the specific questions related to the medical product. Information from the prior studies become the base for the researchers to develop research questionnaire and objectives:

  • Participant selection
  • Number of participants
  • Duration of the study
  • Controlled or not
  • How and what dosage will be given
  • What and when the data will be collected
  • Review and analysis time

Phase 0 Study

It is also called micro-dosing trials, 10-15 human subjects are taken and single sub-therapeutic doses are administered to gather the pharmacokinetic (PK) data of the drug. This enables the company in deciding to go or no go for the further development of the drug, based on more relevant human data instead of animal data.

Such trials exceed the speed of promising drug development by establishing whether or not the drug acts on humans as expected in pre-clinical studies.

After the company decides to take the molecule of the drug forward in development, it will have to submit the data of its preliminary studies to the FDA called Investigation New Drug (IND) application filing.

Phase I Study

Also called First-in-man studies as these are the first stage of human testing studies. These are the studies which are designed to determine the maximum dose that can be administered without showing adverse effects.

Contract Research Organizations (CROs) conduct such studies in the clinical trial clinics where medical staff provides full-time attention to 2-100 healthy subjects enrolled for the study and collects the data.

These studies determine the safety (pharmacovigilance), tolerability, pharmacokinetics (PK)and pharmacodynamics (PD) of the drug. The design of Phase I studies is dose-ranging also called dose escalation studies conducted in controlled clinics called Central Pharmacological Units (CPUs).

Usually, healthy subjects are hired but sometimes terminally ill patients like of cancer and HIV and also those who have already tried and failed to improve on existing medications.

There are two divisions for Phase I study:

Phase Ia: Single ascending dose

Phase Ib: Multiple ascending dose

Phase II Study

More than 100 diseased subjects are enrolled for a longer period study, to know the benefits of the drug along with its safety which includes genetic testing. These studies are also called as “Proof of Concept or Pilot” studies.

This is the phase when the drug’s development can fail due to toxicity or less than expected results.

Two divisions of this phase are:

Phase IIa: Pilot study, to determine the clinical efficacy or the biological activity.

Phase IIb: Dose-finding study, to check the biological activity with minimal side-effects.

A combined trial determining the efficacy as well as toxicity are Phase I/II trials.

Phase III Study

These are pre-registration trials means the data of this study is submitted to the regulatory agency through New Drug Application (NDA) for its registration. Also called Pre-marketing or Pivotal trials.

Such studies are multi-central, randomized, in large diseased population (more than 500) with much longer duration of treatment and short follow up period, to determine the long-term safety and efficacy of the drug.

Even if the regulatory submission is pending, the drug is received by the patients in case it’s a lifesaving drug until the drug can be purchased.

‘Label expansion’ that is drug can treat an additional disease, other than the disease for which the drug is already approved, may also be the reason for running the Phase III trial.

It is said that for FDA (United States Food and Drug Administration) and MHRA (United Kingdom’s Medicines and Health products Regulatory Agency) needs at least two trials of successful trials data to register the drug.

After these trials, the drug is approved for market selling.

Phase IV Study

These are Post Market Safety Monitoring studies done after the drug is registered. Also called Late Phase or Confirmatory trials.

This kind of study determines the long-term adverse effects on the much larger population for a very long duration (at least 2 years). If harmful effects are detected in this study, then the drug is disapproved and the company has to retrieve the drug from the market as it can no longer be sold.

The entire journey of the drug from a molecule to a market selling product takes around 15-20 years.

An Analgesic Pill a Day Keeps the Chills and Aches Away

Over The Counter (OTC) Analgesics or painkillers are drugs that act at different levels of the pain transmission pathway. Aspirin and other non-steroidal anti-inflammatory agents (NSAIDs) and many others act peripherally, while some others agents, such as opioids act on the central nervous system (CNS). While anticonvulsants act on neurogenic pain, muscle relaxants act on pain due to muscle spasm. These analgesics are helpful in pain management; however, they also have adverse effects.

The reasons for the growth of the OTC analgesics market

  • Increasing demand for topical analgesics, which are available as pain-relieving creams, lotions, rubs, gels, and sprays. This has increased the sale of analgesics by 18%, according to Kline Nonprescription Drugs USA report.
  • Increasing global geriatric population is expected to generate higher demand for pain relief products. In the United States, about 23% of the people were expected to cross 55 years of age in 2015.
  • Product innovation to improve performance, in terms of speed and strength, and further, improve the length of the effect.
  • Cost saving, as there would be no need to visit a doctor/physician. It is estimated that the US healthcare system saves USD 6-7 for every USD 1 spent on OTC medicines.

However, anything in excess can take a toll and it is no different with OTC analgesics. The common side-effects include constipation, drowsiness, dizziness, upset stomach, heart attack or stroke. These drugs can cause serious changes in the brain and body. Long-term use of painkillers increases addiction and dependency on the drugs. In the United States, painkillers are the second most abused substances, after marijuana. Pain, in some form or the other, is part of one’s daily life, hence, the need for painkillers.

A report by a market research firm estimates a double-digit growth rate for the Global OTC Analgesics Market, estimated to become a market worth USD 20.79 billion by 2022.

The OTC analgesics market is driven by the better performance of premium-priced branded products as compared to generic OTC analgesics.

Hurdles for the market include:

Uncontrolled prescription of opioids, drug abuse, and unregulated government policies are acting as hurdles for this market.

The Way Ahead:

Innovation in OTC analgesics, like absorption dimension that drives a fast action of analgesics, improved performance, multi-action of analgesics, and high specialization in reducing symptoms of specific ailments, are expected to drive market in the future. Availability of various analgesic drugs in online, owing to increasing number of online pharmacies, is driving the OTC analgesics market.

Beyond Aromatherapy

Aromatherapy in its simplest definition is the smelling of vapors for health & well-being effects, howsoever gained. This article examines a cross-section of the art and proposes a future course of direction for those professionals not wishing to be tarred with an aromatherapy brush.

Of course the fragrance of a nice perfume will leave you in a better frame of mind than the smell of rotting cadavers. The general intuitive appeal of a nice smell (etc) has launched a blind universal hype on essential oils, the mainstay of aromatherapy. Over the years it has attracted a large following of uncritical persons eager to believe good news. By contrast it has produced research well beyond the scope of aromatherapy.

Much opposition has been leveled against the wild claims that border on or even cross the line of fraud. Where there’s money to be made, there is opportunism. The truth is often the first casualty.

Then there is the medical profession. They are the stalwarts to uphold and defend the medical truth. Unfortunately there is opportunity to denigrate the practice of aromatherapy for motives other than altruism, leaving academia to the rescue. Disappointingly, much academic research is in effect unavailable to the general public as good research papers can be expensive.

Deserved or otherwise, alternative medicines such as Acupuncture, Ayurveda, Chiropractic, Homeopathy, Kinesiology, Light Therapy, Phrenology, etc. have been slow to gain traction in mainstream medicine. Within each field there may be something worthwhile. There is risk of throwing the baby out with bathwater.

Aromatherapy by semantic definition is in lockstep with things smelled, the nose being solely equipped to perceive things smelled. Thus aromatherapy armoury consists solely of essential oils. “Essential” not because we can’t live without them but because essential is merely the adjective from the noun “essence” being a vapor from a liquid at a low boiling point.

This semantic deception taken together with people such as those involved in routinely claiming these potions to cure things like ADHD, arthritis, high cholesterol, lupus, asthma, migraines, cancer, fibromyalgia confuses even more. It is there, on offer, all without the rigours of scientific validation. Long Live The Placebo!

Then there are the others making ambiguous claims that leave lots of wiggleroom such as “cleanses air of negative energies”, “restoring harmony and balance between the mind and body”, “restore psychic energy flow”, “return to one’s center and chakra”. These and more have become aromatherapy’s articles of faith in some circles. Most are seen as nonsense to the mind versed in scientific methods.

Contrast these with Moss et al in the peer-reviewed paper “Aromas Of Rosemary And Lavender Essential Oils Differential Affect Cognition And Mood In Healthy Adults” where they showed the efficacy of Lavender and Rosemary oils. 144 persons took part in the study and no one was informed of the study nature. Before and after inhalation tests included 15 words to be flashed on a screen for 1 second and participants were asked to remember as many words as they could in the space of 60 seconds. More tests were done using 20 photographs enabling researchers to test recall and reaction time.

Nominal recall improved from 5.5 for the control group to 6.2 for the Rosemary and showed little change for the Lavender. Nominal reaction time improved from a score of 246 for the control group to 259 for the Lavender. Little change was reported for the Rosemary tests. They concluded that essential oils can significantly affect aspects of cognitive performance.

Worth considering is a paper by Sayorwan et al, who, using electroencephalography (EEG), measured the changes in blood pressure, heart rate, and respiratory rate before and after Rosemary oil inhalation by uniformed groups of subjects and controls. Their findings provided evidence that brain wave activities, autonomic nervous system responses, and mood states could all be modified with Rosemary

Aromas may well have a placebo effect and as such it is a good thing. However it is not the smell that gives essential oils their efficacy but the compounds that comprise the oils. Compounds such as Eugenol, Carvacrol, Thymol, Geraniol, and Menthol appear to stimulate while Linalool appears to calm or relax. Then there is Eugenol, a very powerful antioxidant as well. These compounds can enter the bloodstream via the olfactory system and the lungs through breathing. The bloodstream can also be fed via the skin by massage and contact patches. Other possible routes are ingestion and intravenous injections. The latter are subject to much more research than currently appears in the literature.

In conclusion, the subject of essential oils is therefore a much wider field, rich with potential discovery. Thus it is important that practitioners who prescribe the use of essential oils in their practice divest themselves of any stigma that has grown around aromatherapy. A whole new name for their practice would help to distance themselves from any hint of quackery and dogma.

The general public may well be sceptical as a result of conflicting opinions. The misnomer “essential” does not help. Volatile Oil Therapy (VOT) as a name may engender some trust especially if the practitioners of VOT confine themselves to proven effects.

Healthcare Scenario of Bangalore

HEALTH SERVICES

The health-care scenario in Bengaluru city is a mix of plenty and scarcity. A number of government bodies and schemes provide health services. In infrastructure terms, if all primary health facilities maintained by different government bodies were combined, there are likely to be enough centers to 2 Health care in Bengaluru city – need for a participatory, comprehensive health plan meet the primary care needs of the population. The city is also host to autonomous institutions with high caliber medical professionals, such as National Institute of Mental Health and Neuroscience (NIMHANS) and the Jayadeva Institute of Cardiology. Further, like in other urban areas, a huge private sector caters to the health needs of the population.

Bengaluru is a hub for medical tourism, with super-specialty hospitals boasting state-of-the-art treatment facilities. On the other hand, the communities that particularly need public health services, such as the urban poor and working classes, are unable to access them due to the shortage of medical staff, lack of medicines and diagnostic services, high levels of corruption and the low sensitivity towards their needs. They end up using the private sector, which is an expensive option, or postpone essential health care – an even more expensive option for which the individual, family and society pay a price. There have been cases of women delivering babies at home or in auto-rickshaws as they were turned away at Maternity Homes and did not have time to reach a secondary or tertiary institution, or the resources to get there. Tertiary care is expensive even in government hospitals due to bed charges, medicines and other expenses. The result is high levels of indebtedness and health indicators among the urban poor that are almost as bad as the rural poor.

Government hospitals have a few advantages over private hospitals, which make them better and efficient for patients. This includes their facilities are affordable in cost, which is an advantage for the masses, who cannot afford expensive treatments. Best doctors are majorly found in the southern part of India. Bengaluru has a few government hospitals that make them stand out in other private ones.

In order to make health care available to the weaker sections of society Bengaluru is dotted with numerous government hospitals. Most of the government hospitals in Bengaluru are run and managed by the municipal corporation of the city. The government hospitals in Bengaluru are usually multi-specialty hospitals

Understanding Arthroscopy Surgery

Arthroscopy can be the solution to many types of arthritis and various injuries inside the joint. Also called as key hole surgery, it is the minimally invasive procedure used to examine the inside structure of the joint for the diagnosis and treatment.

The instrument used for this is called arthroscopy. The surgeons can view the area using the video monitor to diagnose and treat the joint tissues. Majorly all the joints in the body can be examined using the arthroscopy. Apart from examining the joint if any other procedure is performed using this, we call it arthroscopic surgery. This kind of surgeries requires lesser recovery times and pain. The tissue trauma will also be minimum. Because of the benefits, it offers arthroscopy is becoming essential for many orthopedic surgeries.

In the arthroscopy procedure, there is no blood loss expected and will have no or minimal complications. Only small incisions are made to examine and insert the arthroscopy. There is no need for opening the joint fully. The incisions are relatively very small and should be maintained dry for few days. And after the surgery, the patients need to stay for little time in the hospital will be recommended different exercises for strengthening the joints.

As said above, arthroscopy is considered in treating many types of arthritis like non-inflammatory and inflammatory. For example, patients with rheumatoid arthritis who have isolated joint swelling can be benefited with this by removing the inflamed joint tissue and examining it to discover any type of infections. This helps the doctors get more information where the diagnosis is difficult just by analyzing joint fluid alone for treatment.

Arthroscopy is also used for treating many knee joint injuries like ligament strains, meniscustears, posterior cruciate ligament, ligament strains etc; not only to treat knee joints and arthritis, arthroscopy is also considered to treat and examine many hips, wrist, feet, spine, ankle and elbow conditions. The arthroscopy is used to treat the wide range of sports injuries involving hips, wrists, ankles, and elbows as well.

Using arthroscopic procedures we can treat spine conditions like spinal deformity, tumors, spine trauma, spine disc herniation and degenerative discs.

The common conditions we treat using arthroscopy include shoulder dislocations, inflammation in knees, shoulders, elbows, and ankles, unstable shoulders, cartilage tears, rotator cuff tears, arthritis and shoulder joint degeneration, shoulder capsule release, cartilage tears and many more.

Arthroscopy surgery is generally performed by orthopedic surgeons. Even though it is a low risk surgery it is highly recommended to get it done by the expert surgeons for the speedy recovery and complete results. So considering arthroscopy over traditional surgery to treat any of the above conditions will assure the patients less pain, minimal complications and faster recovery.

Hernia Treatment Without Surgery Is Becoming Widespread

Generally, hernia requires surgery. But, these days, hernia treatment without surgery is becoming widespread. Yoga hernia exercises are useful for hernia treatment without surgery because it is found that over 30% hernia surgery patients end up with pain and discomfort afterwards. Inserting a foreign net can cause complications later in your 30 to 40 years of post-operation life. Instead of immediate surgery, you can try out gentle yogic stretching in static and dynamic form. This is good for gradually strengthening weak abdominal muscles as it supplies abundant amount of oxygenated blood that nourishes, activates, tones and strengthens. This in turn improves muscle tensile strength which prevent displacement of internal organs. Exercising as a solution for hernia will also safeguard that the hernia does not recur in adjacent area.

You can ask a physical therapist for guidance on exercises that fit your unique condition as patient education & training are key factors in the overall process of physiotherapy treatment. Hernia treatment without surgery will need 1 to 3 months of committed effort and patience to heal.

Piles

Piles are usually inflamed and swollen collections of tissue in the anal area. They can be of any sizes and may be internal or external. Piles are usually caused by increased pressure in the lower rectum. The blood vessels around the anus and in the rectum generally stretch under pressure and may swell, thus forming piles. The symptoms of piles are:

  • Hard stool and constipation,
  • Diarrhea and frequent bowel movements.

Doctors usually diagnose piles after carrying out some physical examinations like digital rectal examination or colonoscopy.

In most cases, piles dissolve on their own without the need for any treatment. But, some piles become severe. Read on to discover some piles treatment that will help significantly to reduce the discomfort and itching.

  1. Diet – Diet change is a must to keep the stools regular and soft. This means you need to eat more fiber, such as fruit and vegetables or bran-based breakfast cereals. You should increase water consumption.
  2. Body weight – Exercising and losing weight help in reducing the severity of piles.
  3. Medicines – Over-the-counter medicines like painkillers, ointments, creams, and pads help to soothe redness and swelling around the anus. Corticosteroids medicines can reduce inflammation and pain. Laxatives are prescribed if a person with piles suffers from constipation.
  4. Surgery – An elastic band is placed around the base of the pile, cutting off its blood supply. In sclerotherapy, medicine is injected to make the hemorrhoid shrink. Infrared coagulation is a device that is used to burn the hemorrhoid tissue. The excess tissue that is causing the bleeding can be surgically removed. Hemorrhoid stapling is done to block the blood flow to the hemorrhoid tissue. Laser surgery is the latest technique for treating piles.

So, multi specialty hospitals have well known doctors for piles treatment where you can get yourself completely cured.

A Hernia Is a Very Painful Disease and If It Goes Into the Last Stage, It Has to Be Operated

A hernia is a very painful disease and if it goes into the last stage, it has to be operated. There are many patients who prefer to go for surgery instead of continuing with the medication because it helps cure fast.

However, there is a different alternative to surgeries and it is becoming more and more popular among hernia patients. Technology has advanced in every possible way in the health section and doctors have come up with amazing solutions to make sure that you can get hernia treatment without surgery. This treatment involves controlling your diet plan, starting an exercise program and also wearing garments that would help heal a hernia. In fact, there are similar cures for piles treatment that doctors have come up with up in the recent time. But, what is it that will help you cure a hernia without having to go for the traumatic surgery? Let’s find out.

A systematic diet

One of the most important parts of treating a hernia without surgery is to have a good diet plan. Just like you have a diet chart when you want to lose weight, similarly there is a specific diet plan when you have hernia. However, it is important that you follow the diet religiously in order to quicken the process of recovery. Foods that are rich in fiber would be ideal for this situation. In addition to fiber rich foods, you should also include lots and lots of fresh vegetables and fruits. Since hernia patients lack minerals and vitamins in their body, it is essential that you eat food that are rich in vitamins and minerals and also zinc. All these will combine together to make collagen so that your skin gets the right amount of protein. A primary concern for hernia patients is their weak collagen content due to which the hernia occurs in the first place.

People exercise for various reasons, but for those who have a hernia, there are also exercises that helps to cure a hernia and prevent patients from undergoing a surgery. The exercises meant for hernia patients are mainly muscle exercises because the abdominal muscles have to be strained in order to cure the hernia. The main target area would be the muscles that lie just below the 6 pack. As those muscles are strained higher towards your stomach, the chances of curing your hernia increases. The most ideal exercise in this case would be Pilates as they directly deal with the abdominal muscles and will not only cure a hernia, but will also prevent it from growing any further.

Change in attire

That is the reason why many companies have come up with abdominal belts and pants that can keep your abdominal muscles tight. This in turn will help in ensuring that the hernia is prevented from getting worse.

A Detailed Insight on Symptoms of Piles

This condition is classified into two types which are:

  • Internal Piles: The internal piles occur within the rectum are not painful due to lack of sensing nerves. At times, it collapses and protrudes outside anal sphincter, which appears like moist pads of skin. This prolapsed haemorrhoids and can be treated with laser surgery for piles.
  • External Piles: The external piles are present in the anus and thus can be more uncomfortable. When this prolapses outside (due to the movement of stool) they become visible. Blood clots occur on them, leading to a painful stage known as thrombosis. When the external piles get thromboses it turns from pink to blue and could even bleed.

What Are The Causes of Piles?

An individual at any age can be the victim of piles. It is a common diseases, that affects over 50% of the people at some point or the other. However, they are usually seen during pregnancy or elderly age, when the haemorrhoids become weak. No matter what the cause behind this condition might be, getting the best piles treatment is of utmost importance.

The four situations that increases the chance of developing piles include:

  • Chronic Constipation
  • Ageing
  • Hereditary factors and
  • Pregnancy

In chronic constipation, excess pressure is applied on the rectum making the veins push against the wall of anus, resulting into feeble and weak anus muscles. This ruptures the haemorrhoids which bleeds making stools even tougher to eject. It is often accompanied with pain and sensitivity. In case of ageing, the tissues present across the lining area get less supportive and affect the haemorrhoids veins.

Similarly, in pregnancy the pressure of baby lying in the anus and rectum breaks the veins and causes piles. Other than that, in certain cases people have inherited weakness at the anal region that makes them prone to this condition.

Know More About the Symptoms of Piles

It must be noted that the symptoms of pile do vary and is influenced by the cause and nature of the condition.

Some of the common signs that are often faced by people are:

  • A feeling of hard lump at the anus region. It is usually coagulated blood that is often seen in external piles.
  • Bright red blood comes out after bowel movement
  • Discharge of mucus when bowels pas
  • A feeling of having full bowel, even after going to the toilet
  • Area around the anus turns sore and red and
  • Itchiness and inflammation at the affected area

A good practice is to consult with a doctor immediately when you come across at least two or more signs of piles.

Analysis to Next Generation Sequencing Technology

With the development of science, traditional Sanger sequencing has failed to meet new requirements of low cost, high throughput and fast in speed.

Recent years, with the discovery and promotion of second-generation sequencing technology, the gene sequencing speed has increased greatly while achieving a substantial decline in costs, making large-scale application of genome sequencing possible. Now, the cost of personal whole genome sequencing is about 5,000$, and is expected to decreased to less than $ 1,000 in the next few years.

The rapid development of sequencing technology will promote the massive accumulation of DNA sequencing data, accompanied by the accumulation of the corresponding individual diseases, signs and other data at the same time. When we accumulate enough data, how to understand these data will be critical. On the micro level, generations of molecular biologists’ studying the effects of apparent biological traits genes exert on utilizing technologies like gene knockout have made breakthroughs in many crucial aspects. On the macro level, statistics and other data analysis techniques are introduced to study the relationship between gene sequences and biological phenotype. The accumulation of basic scientific research gradually brings breakthroughs in clinical applications.

There are now two types of clinical applications mainly, one aims at disease screening of ordinary people. It infers people’s future risks of getting cancer by measuring the known genes associated with a disease loci. The other aims at the diagnosis cancer and other deadly diseases. It finds in a series of drugs or plans the most effective one for certain patients by testing the loci of certain genes.

Data from BBC research shows that total global gene sequencing market increased from $ 7.941million in 2007 to $ 4.5 billion in 2013, and will reach $ 11.7 billion in the year of 2018 with the CAGR up to 21.2%.

Currently, the market of de novo sequence platform is mainly taken by several major manufacturers, including the Illumina, Ion Torrent / Life Technologies (was the acquisition of Thermo Fisher in 2014), 454 Life Sciences / Roche, etc.

Under such a circumstance, the next generation sequencing technology (second-generation sequencing) appears. As an emerging industry, the next-generation sequencing technology can be applied in clinical testing like antibody discovery, health industry, industrial and agricultural use of gene-oriented study as well as scientific research and development.

To stimulate the next generation sequencing market, we need to start by investing more small and medium size industry focusing on this field.

Glomerulonephritis: How to Diagnose and Prevent It at Various Levels

Glomerulonephritis is an inflammation of the glomeruli in the kidney. The glomeruli is constellation of small blood vessels in the kidney that act as a filter to remove excess fluid, electrolytes and nitrogenous wastes from the blood into the urine.

It is divided into:

  • Acute Glomerulonephritis- The symptoms develop suddenly.
  • Chronic Glomerulonephritis- The symptoms develop gradually.
  • In glomerulonephritis, the glomeruli lose their filtering capacity thus blood proteins and red cells are excreted in the urine in various quantities depending on the severity of the glomerular damage.

DIAGNOSIS OF GLOMERULONEPHRITIS

Accurate diagnosis is essential in the successful treatment of glomerulonephritis.

Diagnosis is highly dependent on the clarity of symptoms, examination and investigation findings.

SYMPTOMS

  • Passage of coca-colored urine due to the presence of red blood cells in the urine. This is called haematuria.
  • Passage of foamy urine due to excess amount of proteins in the urine. This is called proteinuria.
  • Presence of peri-orbital and ankle swelling.

EXAMINATION FINDINGS

  • Peri-orbital and pedal edema.

ยท Elevated blood pressure.

INVESTIGATIONS

  • Urinalysis-This reveals diagnostic findings such as red blood cells, casts, white blood cells and proteins in the urine.
  • Blood test- Blood level of electrolytes, urea and creatinine. This is mainly done to assess the extent of kidney damage.
  • Radiological imaging tests-This is done usually when the blood tests suggest some level of kidney damage. E.g Renal scan or abdominal CT scan is done.
  • Kidney biopsy- This entails using a clinical procedure to extract some pieces of kidney tissues for microscopic examination. This is the only test that confirms glomerulonephritis.

TREATMENT

This is based on the following principles:

  • Treat underlying health conditions quickly.
  • Use of corticosteroids to reduce the degree of inflammation and immunological responses.
  • Dialysis- This is used for individuals with acute kidney injury or kidney failure.
  • Anti-hypertensives such as ACEI, ARBs- This is used to control hypertension in some selected individuals.

PREVENTION STRATEGIES

There are 3 levels of prevention namely: primary, secondary and tertiary.

PRIMARY PREVENTION

The aim of this is to prevent the onset of glomerulonephritis.

It entails the following:

  • Throat swab should be done for suspected bacteria cause of sore throat. If streptococcus is suspected, oral penicillin should be commenced as soon as possible.
  • Prompt treatment of individuals with bacteria endocarditis.

SECONDARY PREVENTION

This involves early diagnosis and prompt treatment of glomerulonephritis.

It specifically entails the following:

  • Routine urinalysis to be done periodically for individuals at risk of streptococci infections and for individuals greater than 40 years.
  • Periodic monitoring of blood urea and creatinine levels should be done for individuals with compromised kidney function.

TERTIARY PREVENTION

This involves activities and interventions put in place for individuals with glomerulonephritis from developing complications such as kidney failure and to reduce the disease progression.

  • Optimal control of co-morbidities like hypertension and diabetes mellitus.
  • Reduce intake of high protein diet.
  • Restrict salt intake.
  • Cessation of smoking.
  • Regular clinic follow up by a Nephrologist.

Finally, glomerulonephritis is a very lethal kidney disease of which the onset and progression can be prevented if an individual adheres to the activities in the various levels of prevention highlighted above.