Magdy

1. Case Presentation
By
Magdy Elsaeed

2. History
 A 12-year old female, presented to ER
with:
◦ pallor
◦ easy fatigability and persistant
vomiting

3. History
Present history
The condition started 3 week ago by
gradual onset and progressive course
of vomiting associated with oliguria.
Took ttt of typhoid fever

4. History
Past history
No history of hypertension,
diabetes, CKD, surgery.
History of intermitent colchicine
intake.

5. History
Family history
Not significant

6. Examination:
O/E:
 The patient appeared ill, fully
conscious.
 BP: 120/70 mmHg, pulse 100 b/m,
afebrile.
 Chest: normal vesicular breathing
 Heart: normal S1,S2, no added
sounds.
 Abdomen: lax, no palpable organs.
 Bilateral mild pitting L.L. edema below

7. Investigations:
7 gm/dL (micro-hypo)
7800
598000
Full Blood Count:
Hb.:
TLC:
Platelet count:
0.52 mg/dL
2.1 gm/dL
19
44
Total Bilirubin:
Albumin:
ALT:
AST:
1.25INR:
96CRP:

8. Investigations:
++
4-6 /HPF
Absent
Over 100 cells/HPF
Urine analysis:
Protein:
Pus cells:
Casts:
RBCs:
11 mg/dl
152 mg/dl
5.5
Renal profile:
Serum creatinine:
Blood urea:
K
7.52
15 mmHg
12 mmoL/L
ABG:
PH:
PCo2:
HCo3:

9. Investigations – cont.:
Pelvi-abdominal US:
 Bilateral normal kidneys as regard size,
grade 3 echogenicity and poor CMD
with no stones or back pressure.

10. History

11. Management:
 The patient took 2 HD sessions
 Lab requested:
ANA ,anti ds DNA , C3-C4
C-P ANCA , blood film
Planned for renal biopsy
refered to children hospital in Mansoura