Dera Kiran, We usaully experience the same in our Community Based Management of Acute Malnutrition programme in Malawi, where sometimes service providers confuse Nephrotic Oedema and Nutrition Oedema. I am assuming there would be possibilities of an overlap, however, there should be caution taken when managing that situation, so that the treatment of one should not worsen the other. In order to diffrentiate the two, note that Nutrition Oedema is usually characterised by pitting where a dent is formed following 3 seconds thumb pressure and I expect Renal Oedema not to pit.

but how shd the nutritional management go in such a case?? also, what causes the pitting in nutritional edema???

Dear kiran Though these cases are very rare,i think you did management of such case,in your exprience how did you treat this case ? and also what is your advice to wards like this case.

Has the possibility of Post Streptoccocal GlomeruloNephritis, been investigated, which may need a public health intervention as well to reduce the spread. Children with PSGN have hypertension, haematuria, proteinuria, oliguria, oedema. The fluid restriction during initial nutritional treatment (if she was on F75) treatment may have reduced the swelling and once completed the oedema return. Just a possibility!

dear all, it seems ,after all, she was just a case of kwashiorkar! no renal involvement could be confirmed

I don´t think renal oedema is a non pitting one, so, in my opinion, it is not useful to distinguish between nutritional and renal oedema.

we have experienced nutritionist on same page so we can get better answer. can any one distinguish the nutritional and nephritic edema? if both are present in any one case then how we will identify ? if yes , then what should be our next step?\ Thanks in advance for your response.. cheers.................

to distinguish the nutritional and nephritic edema for an individual to know that this is nutritional edema it has to be through assessment of the child and it is by assessing the using the thumbs pressed on the feet of the child if the edema is pitting and presents in both feet and it starts from the feet when the condition deteriorates it increases to legs face. while for for nephritic edema it is not pitting usually does not start from the feet . if both are present in order to come up with a clear clinical picture on that one you have to include clinical assessment that include medical history & physical examination that will help to rule out other medical conditions and to come up with the right diagnosis. if yes then the child will be treated as having both conditions hence will be treated for both that is for nephritic and nutritional edema

where does the nephritic edema begin?? if it begins at some other site than legs,is it safe to assume that it is nutritional edema??