2. Particulars of Patient
Name - Mahmuda
Age - 2 years 6 months
Sex - Female
Address - Mirzapur, Tangail
Date of Admission - 03. 03. 20
Date of Examination - 03. 03. 20
Informant - Mother
3. Presenting Complaints
1. Swelling of the whole body for 15 days.
2. Scanty Micturation for 15 days.
3. Passage of red colour urine for 9 days.
4. History of Present Illness
According to the statement of mother, her child was reasonably well
15 days back. Then she developed swelling of whole body which first
appeared on face and gradually became generalized and associated
with scanty micturation which gradually decrease in volume &
frequency for same duration. Pt’s mother also complained of passage
of red coloured urine which was uniformly red throughout the period
of urination. With these complaints he was admitted into Dhaka Shishu
Hospital for further evaluation and better management.
5. History of Past Illness
There was no significant past illness.
Treatment History
Pt’s wasn’t on any drugs till admission.
6. Birth history
Delivered by LUCS at term without any complication.
Feeding history
She is on Family diet.
Developmental history
Age appropriate.
7. Immunization History
Immunized as per EPI schedule.
Family History
2nd issue of non consanguineous parents. No family history of
such type of illness.
Socioeconomic History
Belongs to lower middle class family.
8. General Examination
Appearance - Puffy face
Anaemia : Mildly Anaemic (+)
Cyanosis
Jaundice Absent
Clubbing
Koilonychia
Leuconychia
13. Alimentary & Genitourinary System Examination:
Inspection:
Abdomen is distended.
Flanks are full.
Umbilicus: Centrally placed, everted.
No visible pulsation or scar mark.
14. ALIMENTARY & GENITOURINARY SYSTEM contd.
Palpation :
Abdomen non tender.
Liver: Not palpable.
Spleen: Not palpable.
Kidneys: Not ballotable.
Renal angle: Non tender.
Fluid thrill: Absent.
17. Respiratory system examination cont:
Palpation:
Trachea is centrally placed
Apex beat : felt over left 4th ICS medial to the midclavicular line
Symmetry of chest:
Chest expansion : Normal
Vocal fremitus :
18. Respiratory system examination cont:
Percussion:
Percussion note: Resonant along the mid-clavicular, mid-
axillary & scapular line.
Auscultation:
Breath sound is vesicular, no added sound
Vocal resonance is normal
20. Salient features:
Mahmuda, 2 years 6 months old immunized young girl presented
with swelling of whole body started from face and scanty
micturation which was gradually diminished in volume &
frequency for 15 days with passage of red coloured urine for 9
days. She had no significant past illness. She was mildly pale,
normotensive having puffy face with anasarca. Bed side urine
albumin was 3+ & ascites was present. Her Respiratory and other
system revealed no abnormality.
27. • Counseling of the parents.
• General supportive measure :
Nutritional advice : Normal balanced diet with adequate protein
(2-2.5 gm/kg/day)
Vitamin & Mineral supplementation: Calcium supplementation
Treatment:
28. Treatment cont…
• Control of edema:
Salt restriction
Infusion of 20% albumin (0.5-1.0g/kg) with Inj. frusemide
• Prevention of infection :
Inj. Ceftriaxone 100mg/kg/day daily in two divided dose for 5 days
Inj. Amikacin 20mg/kg/day daily in two divided dose for 4 days
• Others:
Omeprazole Sachet 1 pack mixed with ½ glass of water once daily Before Meal
Tab. Folic Acid 5 mg once daily
29. Specific treatment :
Syp. Prednisolone 24 mg (2mg/kg/day ) in single morning dose for 6
weeks,
Followed by
1. Syp. Prednisolone 18 mg (1.5 mg/kg/day) in single morning dose
on every alternative day with gradual tapering over 3 months
2. Tab. Calcium 500 mg ???
30. Follow up:
In hospital:
Record of vital signs: Pulse , BP, temperature
Weight
Edema
Abdominal girth
Intake-Output
BSUA
31. After discharge :
2 weekly follow up, then monthly follow up to note
Response to drug
Toxicity of drug
Any infection