A Patient of Anasarca- Road to Diagnosis
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This slide contains the approach to a patient of generalized body swelling, discussion on need of renal biopsy & Management of glomerulo nephritis.
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A Patient of Anasarca- Road to Diagnosis
- 1. DR. AZIM ANWAR MD, PHASE-A RESIDENT DEPARTMENT OF CARDIOLOGY BSMMU
- 2. Name: Mr. Shawn Age: 24 years Marital status: Married Occupation: Businessman Adress: Mohammadpur, Dhaka Admitted on 17/04/2018
- 3. 1. Generalized body swelling – 7 days 2. Scanty micturition for same duration
- 4. Developed sore throat 1 month back Resolved with antibiotic and subsequent course was uneventful He developed generalized body swelling specially puffiness of face & eyes after waking up in the morning for last seven days. Associated with scanty micturition. Diagnosed as hypertensive.
- 5. No history of Shortness of breath Orthopnea PND Cough or sputum production.
- 6. ◦ Not associated with Prior sore throat Hematuria Jaundice Arthralgia Oral ulcer Heat or cold intolerance No history of nephrotoxic drug ingestion
- 7. No significant history of past illness.
- 8. His parents are alive. He has 3 siblings. H/O DM in first degree relatives. No H/O renal disease or CVD in his family
- 9. Low socioeconomic status
- 10. Non smoker No allergic history to any drug or food Immunized as per schedule
- 11. Conscious, Oriented & Co-operative Puffy face Anaemia + Non icteric Oedema ++ Weight –55 kg Pulse – 88 beats /min, regular BP - 160/80 mmHg Temp – 98º F
- 12. Respiratory rate – 18 breaths/min No lymphadenopathy Thyroid gland: normal JVP : not raised Bedside urine dipstick reveals: +++ Proteinuria
- 13. Umbilicus is centrally placed & inverted. Flanks are not full Abdomen is non tender No organomegaly No ascites
- 14. Inspection: Normal Palpation: Trachea central in position. apex beat palpable at left 5th ICS medial to midclavicular line. Percussion: Resonant Auscultation: Breath sound vesicular.
- 15. Other system reaveal no abnormaity.
- 16. INVESTIGATION
- 17. 04/04/2018 09/04/18 Protein ++ +++ RBC Nil 10-12/HPF Pus cell 12-15/HPF 10-12/HPF Cast Not found Not found Urine C/S No growth
- 18. 11.04.2018 UTP 2.4 g/day UTV 1500 ml/day
- 19. 04.04.2018 09.04.18 18.04.18 S.Creatinine (mg/dl) 1.5 1.3 1.3 Na+ (mmol/L) 138 142 K+ (mmol/L) 6.2 5.5 B. Urea 38.6 mg/dl S. Albumin 37 g/L
- 20. Date 18.04.18 Hb% (gm/dl) 13.7 ESR (mm in 1st hr) 65 WBC (/µl) 8200 N-45% L-35% E – 15% Platelets(/µl) 240000 MCV 73 FL
- 21. Date 18.04.2018 ANA Negative Anti ds DNA Negative C3 g/l 0.169 ( 0.9-1.8) C4 g/l 0.222 (0.1-0.4) HBsAg Negative Anti-HCV Negative P-ANCA C-ANCA Negative
- 22. Rt. Kidney 10.4 cm & Lt. Kidney 10.7 cm CMD – well maintained Cortical echogenicity – reduced Pelvicalyceal systems are not dilated. Urinary bladder wall is regular COMMENTS : Normal findings.
- 23. Tab. Frusemide 40mg 1+0+0 Tab . Nefidipine SR 20mg 1+0+1
- 24. What is the probable diagnosis?
- 25. What is the probable diagnosis? Decision regarding renal biopsy?
- 26. What is the probable diagnosis? Decision regarding renal biopsy? Plan of further management?