about nephro patho meeting

1. Nephro-Path Meet
29/10/2022

2. PATIENT
11 year male
Student of 7th class
Resident of Gonda U.P.
DOA – 24/09/2022

3. PRESENTING
COMPLAINTS
 Fever for 1 day 9 day back , high grade 102 F /
intermittent
 Vomiting – 3 to 4 time / day x 7 days
 Swelling all over body x 7 days
 Decrease urine output x 7 days

4. NEGATIVE
AND
PERSONAL
HISTORY
 No h/o rash , SOB , ear discharge, no h/o recent RTI
 No h/o LUTS
 No h/o swelling in past
 No h/o nocturia
 No h/o renal calculus
 Birth order 3, hospital, NVD , Birth weight -3 kg
 Normal development
 Immunized till date

5. Examination
General Examination-
 BP- 90/60 mmHg
 PR- 100/min , normovolemic, regular, synchronous, no radio radial
and radio femoral delay
 RR- 22/min
 Pallor +nt
 Generalized body edema present
 No dyspnea, cyanosis, jaundice, lymphadenopathy

6. Systemic
Examination-
Respiratory system-
• B/L NVBS +nt in all lung
fields
• No added sound
Cardiovascular System-
• S1S2 heard over all over
precordium
• No Rub /Murmur is present
Abdominal system-
• Soft
• All quadrant are moving
equally
• Bowel sound +nt
CNS System-
• Conscious, oriented to time,
place and person.
• All higher function are intact
• Motor and sensory system
are intact

7. Investigation
22/09/22 23/09/22 24/09/22
Hb 10.5 9.9 11
TLC 26.8 24.5 14.58
DLC N66L9 N84 N78
PC 3.13 3.24 3.35
Urea 242
S.Creat 6.09 8.15
Na+ 131
K+ 5.86
Ca++ 8.10
Phos-- 7.60
UA 13.60
S. Bilirubin 0.80 0.34
S.ALbumin 3.19
SGOT/PT 21/57 15/11
S.ALP 209

8. Investigation
26/09/22
C3 18
C4 11
iPTH 172
VIT D 15
PCT 0.93
PT/INR 13.7/1.06
VIRAL
MARKERS
NEGATIVE
URINE R/M 22/09/22 24/09/22
SUGAR NIL NIL
PROTEIN ++++ ++
WBC 60 - 80 2 - 5
RBC FULL FEILD 30 - 50
COLOUR COLA
BLOOD C/S 24/09/22
STERILE
USG W/A- on 25.09.2022
RK- 9.8x3.8,LK-9.6x4cm
b/l Echo increased and
normal CMD

9. CLINICAL
DIAGNOSIS
RAPIDALY PROGRESSIVE RENAL FAILURE
RPGN
? MPGN ? C3 GN ? PSGN

10. TREATMENT
 MANAGEDWITH SUPPOTIVECARE
 I.VANTIBIOTICS
 HYPERTENSIVE DURING HOSPITAL STAY – ANTIHYPERTESIVE
STARTED
 MULTIPLE SESSIONOF HEMODIALYSIS

11. Renal biopsy on 30-09-2022

12. TREATMENT
 STEROID STARTED ON 30/09/2022. MPS PULSE F/B ORAL
PREDNISOLONE

13. OUTCOME
 URINEOUTPUT IMPROVEDAFTER STARTING OF STEROID
 RENAL FUNCTION STARTED RECOVERING
 LAST HD DONEON 02/10/2022
 DISCHARGEDON 08/10/2022
 DIALYSIS INDEPENDENTAT DISCHARGE

14. INVESTGATIONS
04/10/22 07/10/22 10/10/22 12/10/22 15/10/22
Hb 7.8 8.6
TLC 14.10 16.2
DLC P61L25 P81L15
PC 3.35 3.3
Urea 126 110 68 55 40
S.Creat 4.19 2.92 1.24 1.11 0.78
Na+ 130 144 140 138
K+ 3.3 3.41 3.35 4.0
Ca++ 8.8 9.7
Phos-- 2.6 3.2
U A 4.6 4.12

15. URINEOUTPUT
AFTER STEROID
(30/09/2022 =
DAY1)
60
250
350
400
900
1000
1500
2100
DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 DAY 8
URINE OUTPUT IN ML

16. S.CREATININE
AFTER
STEROID
(30/09/2022 =
DAY1
5.77
4.19
3.6
2.92
2.6
1.24 1.11
0.78
DAY 1 DAY 4 DAY 5 DAY 7 DAY 8 DAY 10 DAY 12 DAY 15
S. CREATININE
S. CREATININE

17. THANKYOU