Dr yara case

1. By
Yara Ahmad
Resident nephrology
NMGH
CASE PRESENTATION

2. PERSONAL HISTORY
Male patient aged 55 years old ,teacher, from
Meniat Samnoud, has 3 offspring the
youngest one is 13 years old
Heavy smoker for 30 years ago

3. COMPLAIN
Swelling of face and lower
limbs

4. HISTORY OF PRESENT ILLNESS
• The condition has been started 3 weeks ago
by oedema of eye lids and both legs with
gradual onset and progressive course
• Frothy urine
• Weight gain about 10 KG
• The patient asked the medical advise and
the condition improved with diuretics

5. PAST HISTORY
• Hypertension for 7 years on Epilat and
Alkapress
• DM for 7 years on OHG Novonorm

6. FAMILY HISTORY
• History of ckd ( father)
• History of hypertntion and DM

7. ON ADMISSION
• Patient was conscious , oriented
• BP 130/90
• Pulse 80/min regular
• Bilateral lower limb oedema
• Puffiness of eye lids
• Chest normal
• Heart normal
• Abdomen normal

8. LABORATORY INVESTIGATION
• Serum creatinine 6.5
• Urea 200
• Hgb 12.5
• Na 139
• K 5.1
• Prothrombin time 12.
• INR .95

9. • albumin 3.6
• Po4 6.7
• Platelet 103
• Ph
• 7.23
• Hco3 19.7
• Pco2 47
• RBS 152
• Ca 7.4

10. • Protein in urine 8 gm/24 hours
• Pus cells 3-5
• RBCs 30-35
• T.Bil 1.3
• D.Bil .30

11. IMAGING
• Right kidney : small size 6.7×3 cm with
marked increased ecchogenecity , few
cyst
• Left kidney :average sized 11×6 cm with
mild increased ecchogenecity with
preserved CMD differentiation , few cyst
• Normal colour indicies of both renal
arteries
• No evidence of RAS

12. LATER
Date cr urea Hb Wbcs Plt Alb Na K
19/2 6.5 200 12.5 9.90 103 3.6 139 5.1
20/2 6.7 122 12.2 8.30 115 3.4 144 4.7
21/2 13 9.20 134
22/2 6.9 231 13 8.20 109 3.9 140 4.3
23/2 7.1 252 11.3 7.20 111 139 4.6

13. PROTHROMBIN TIME
20/2 12.6
22/2 13.9
23/2 13.1

14. FLUID BALANCE
• Total (24 hr) intake 800 cc
• Output 1100 cc

15. 22/2/2018
• Renal biopsy was taken and waiting for
results
• Patient on lasix 40 mg / 8h , Alkapress
10 mg 1tab/ day , Zantac amp/ 12h

16. DIABETIC NEPHROPATHY
• the early evidence of diabetic nephropathy
is microalbuminuria (low but normal ) >
30mg/day
• Albuminuria >300mg/day on at least 2
occasions 3months apart
• Increase BP
• Progressive decrease in GFR

18. DIFFERENTIAL DIAGNOSIS
• Diabetic nephropathy
• Secondary focal segmental
• Other causes of GN

19. RENAL BIOPSY IN DIABETIC
NEPHROPATHY
• No diapetic retinopathy
• Dysmorphic red cell , red cell casts or
macroscopic hematuria
• Rapid onset rapidly increasing or massive
protinuria
• Rapidly decresing GFR
• Symptoms or signs of multisystem disorder