Comparison of clinical outcomes following early rehabilitation in 3 cases of nephrotic syndrome with different treatment
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CASE REPORT
Comparison of clinical outcomes following early rehabilitation in 3 cases of nephrotic syndrome with different treatment courses Kohji Iwai1 · Yasuhiko Hatanaka2 · Tamiro kawaguchi3 · Shin‑ich Araki4 Received: 16 February 2020 / Accepted: 23 April 2020 © Japanese Society of Nephrology 2020
Abstract There have been few published reports regarding rehabilitation for nephrotic syndrome. We compared the clinical outcomes of three cases of nephrotic syndrome with different treatment courses during 5 weeks of early rehabilitation. We report on three cases of nephrotic syndrome. Case 1 was a 67-year-old male who showed good progress after steroid treatment. Quadriceps torque and exercise capacity were increased after intervention. Case 2, a 78-year-old male, demonstrated resistance to steroid treatment. Quadriceps torque was decreased and exercise capacity was increased after intervention. Case 3 was an 83-year-old male who received nutrition therapy and diuretics without steroid treatment. Quadriceps torque and exercise capacity were decreased post-intervention. Early rehabilitation should be considered even if the steroid treatment course is different; furthermore, it is necessary to carefully consider the optimal exercise load in patients with nephrotic syndrome for whom regardless of whether or not steroid treatment is used.
Introduction In Japan, approximately 13.3 million adults experience chronic kidney disease (CKD) according to a survey by the Japan Society of Nephrology [1]. Many patients show prolonged survival due to high healthcare standards for dialysis. Patients with CKD who undergo dialysis demonstrate decreased physical exercise [2, 3] and a comprehensive program of kidney rehabilitation has been recommended for patients with disorders related to renal diseases and dialysis [4]. Accumulating evidence in kidney rehabilitation suggests that it results in improvements of malnutrition–inflammation complex syndrome [5], assimilation of muscle protein [6], quality of life [7], and exercise capacity [8]. * Kohji Iwai [email protected]‑med.ac.jp 1
Division of Physical Therapy, Rehabilitation Units, Shiga University of Medical Science, Seta Tsukinowa‑Cho, Otsu, Shiga, Japan
2
Graduate School of Health Science, Suzuka University of Medical Science, Suzuka, Mie, Japan
3
Department of Rehabilitation, Shiga University of Medical Science, Otsu, Shiga, Japan
4
Department of Nephrology, Shiga University of Medical Science, Otsu, Shiga, Japan
Most of the prior studies in this area included patients with stable CKD who received regular dialysis, rather than patients with nephrotic syndrome. We previously reported the safety and efficacy of early rehabilitation in nephrotic syndrome [9]; however, cases for which steroid treatment was not indicated were excluded. In the present study, we compared the clinical outcomes of three cases of nephrotic syndrome with different treatment courses over a 5 week period, and compared the safety and efficacy of early rehabilitation.
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