A 15 year old girl presented to the opd today with the complaints of
Bilateral lower limb swelling since 15 days
Reduced urine output since 10 days
Abdominal distension since 5 days
Facial puffiness since 3 days
Dyspnea at rest since 3 days
Non productive cough since 3 days
Fever since 1 day
She was born out of a 3rd degree consanguinous marriage. She has 2 healthy siblings. Her father expired when she was 10 years old, he was a chronic alcoholic, according to her mother who is unsure regarding the cause of his death, she attributes it to ? Respiratory Failure and Liver failure .
According to her mother, her father's elder sister had a kidney disease due to which she expired.
When she was 6 years old - she experienced cough along with dyspnea and low grade fever after which she was diagnosed to have pulmonary kochs for which she used ATT for 6 months.
Her mother works as a daily wage laborer.
She finished her 8th grade, she as well is currently working as a daily wage laborer along with her mother.
At 15 years of age - she attained menarche
15 days back she developed bilateral lower limb swelling extending upto her thighs.
She later developed a cystic lesion near her vagina which burst after she got it excised in a local hospital after which there was a serous discharge.
10 days back she developed reduced urine output following which she developed
Abdominal distension since 5 days after which she developed
Facial puffiness, dyspnea at rest at 3 days along with non productive cough since 3 days
With these complaints she visited a hospital in Hyderabad where in she was told to have a kidney problem
On 4/10/2021
Her weight on 4/10/2021 was 55kg
Her serum creatinine was 1.3g/dl
Urine showed albuminuria 4+
Along with 4-6 rbcs and 10 - 12 pus cells, 2 - 4 epithelial cells
Her spot protein creatinine ratio was more than 7.2
Her spot urine creatinine was 150mg/dl
Spot urine protein was 940mg/dl
Her USG abdomen revealed bilateral pleural effusion
And showed raised echogenecity of Kidneys
Ascites
She was prescribed Tab Lasilactone 20/50 BD
Along with Tab Omnocortil 60mg OD
Tab Metolazone 2.5mg OD which she took for 3 days
She also has been experiencing low grade fever since yesterday night.
On examination:
Mild erythematous rash on her cheeks +
Pallor was present along with bilateral lower limb edema
RR - 26cpm
PR -102bpm
BP- 120/80mmhg
Afebrile
Abdominal -
Distended
Bowel sounds +
Lungs -
Inspiratory crepts in bilateral IAA,ISA
Cvs - S1,S2+
Diagnosis -
Nephrotic syndrome
INVESTIGATIONS DONE OUTSIDE:
ON 29/9/21:
HB: 9.2
WBC: 10,800
PLT: 3.05
BGT: B +
ALBUMINURIA - ++++
PUS CELLS 10-12 CELLS
RBC - 4-6 CELLS ( WAS IN MENSES )
10 DAYS BACK - RAPID FOR COVID - NEGATIVE
ON 4/10/21:
S.CREATININE: 1.3
S. CHOLESTEROL : 450 MG / DL
SPOT PCR- 7.2
Investigations done at our hospital:
7/10/2021
Hb - 10.9 gm/dl
TLC - 9100 cells/cumm
Platelets - 2.54 Lakhs /cumm
MCV - 76.6
MCHC - 35.5
Peripheral smear - Normocytic normochormic
Her blood urea here today is 206mg/dl
Serum creatinine of 2.1mg/dl
Serum albumin of 1.8mg/dl
Complete Urine Microscopy:
Showing Granular casts
Showing dysmorphic RBCs
Showing 4+ Albuminuria, 8- 10 dysmorphic rbcs, 10-12 pus cells, epithelial cells 12-14 cells/HPF
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