nephrology

1. Case presentation
Dr Tayseir Ashraf
NEPHROLOGY RESIDENT
MANSOURA NEW GENERAL
HOSPITAL

2. A 36 yr. old Female patient from Aswan
, housewife , married , and has two
offspring , the youngest is 3 yrs old ,
no special habits of medical importance
.
PERSONAL HISTORY

3. complain
Abdominal pain .
Lower limb swelling .
Elevated renal funcion test .

4. PRESENT HISTORY
 The condition started one month ago
with anuria after abortion , acute onset ,
progressive course associated with
abdominal pain , fatigue , dyspnea &
elevated renal function test.
Admitted at Aswan hospital in ICU → pt
became oliguric , L L edema → referred
to our hospital .

5. PAST HISTORY
 History of abortion 6 months ago .
 NO history of similar condition.
 No history of renal disease .
NO history of chronic illness

6. DRUG HISTORY
NO history of NSAID
NO history of nephrotoxic drugs .

7. Family HISTORY
NO family history Of renal disease .

8. Investigations which done in
Aswan Hospital
7.2Bilirubin
total
4.39Bilirubin
direct
2.91Bilirubin
indirect
3.2Alb
26.5Lupus anticoagulant
1638Alb / creat ratio
6.7Tlc
6.2Hb
100Plt
6.1s.Creat
140Urea
3.2K
141Na

9. c3 Normal
C4 Normal
ANA Negative
Ds- DNA Negative
virology
NegativeHCV
NegativeHBsAg
NegativeHIV abs
Blood gases
7.23Ph
32.8pco2
16.27Hco3
Urine
analysis
**Protien
*Sugar
granular &casts

10. In Aswan hospital
Pt received 7 sessions of hemodialysis &
conservative treatment …
BUT , didn’t improve → referral for
renal biopsy …

11. Renal biopsy

13. Then patient referred to our
hospital for management ..

14. CLINICAL EXAMINATION
 Patient is fully conscious .
 B p ;160/90
 Pulse ; 88 , regular
 Temp ; 37
 Neck ; Rt Jugular temporary catheter from 3 weeks.
 Chest ; clear
 Heart ; free
 Abdomen ; lax , mild ascites & mild splenomegaly
 Mild L.L edema

15. Abdominal US
Kidney ; both kidneys show increase in size
with mild to moderate increase of echogenicity .
LIVER ; mild ascites , mild enlarged .
Spleen; mild enlarged .

16. labs
lab
7.2HB
8.3TLC
501PLT
9.5S.CR
78UREA
4.4S.K
136Na
3.2Alb
7.39PH
21HCO3
39PCO2
NormalC3
NormalC4
NegativeANA
NegativeAntidsDNA
NegativeCANCA
NegativePANca

17. Then we decided
plasma exchange …

18. Treatment
 Started plasmapharesis at 20/12/2018 →
session every other day , pt received 5
session .
 Conservative treatment .

19. DAILY LABS
30/1
2
29/1
2
28/1
2
26/1
2
24/1
2
22/1
2
20/1
2
19/1218/1217/1216/
12
LAB
S
9.98.67.27.26.68.787.57.96.67.2HB
6.544.93.35.26.66.15.95.78.88.3TLC
418408365250255291380372337312501PLTS
10.710.811.612.111.81213.912.311.411.59.5S.CR
135115119110112958881607178URE
A
3.84.34.55.43.74.843.33.53.14.4S.K
137135136134137135134138134135136Na
4.13.83.73.23.132.63.12.82.93.2Alb

20. Fluid chart
16/1
2
17/12 18/12 20/12 22/12 23/12 25/12 27/1
2
29/12 30/12
INPUT 900 1700 1300 550 2500 2635 850 3200 3900 3100
OUT
PUT
700 1950 1350 750 3000 3600 3600 3400 1550 3700

21. After that
2/11/131/12labs
99.7Hb
6.97.3Tlc
463486Plt
6.87.6s.Creat
98104Urea
6.35.7s.K
135142Na
3.43.2Alb
2/11/131/12Fluid
chart
150034001800Input
160039002000Output

22. treatment
Receive session HD .
Solupred 20 mg .

23. THANK YOU