A 2.5-year-old male patient presented with a 5-day history of generalized and painless swelling, raising suspicion of nephrotic syndrome, likely minimal change disease. Initial examinations and lab results indicated edema, low serum albumin, and high cholesterol levels. Recommended treatment included cefixime, prednisolone, and an antacid, with renal biopsy suggested for confirmation.

1. Clinical case
Course title : clinical pharmacy
Course code : 716-P
Course incharge : shumaila qadir

2.  Name: Rhythm
 Age: 2.5 years
 Sex: Male
PATIENT MEDICAL HISTORY
• Reported to the pediatric emergency with
the chief complains of Generalized swelling
of the body X 5 days .
• Swelling started from the face followed by
swelling of abdomen , upper and lower
limbs.
• No h/o of rash , fever, sore throat, fast
breathing
• Patient was taken to the local hospital and
some medicine was given, a USG was done
and referred to tertiary care

3. • The patient was apparently well 5 days back when his mother
noticed swelling of her face, which was acute in onset and
gradually progressing towards the abdomen and bilateral upper
and lower limbs.
• The swelling is painless and pitting in nature.
• The overlying skin was normal and there is no history of itching and
rashes.
• No h/o frothy urine ,yellowish discoloration of urine
• No h/o cough, chest pain
History of Present Illness

4. • No h/o altered bowel habit and bladder
• No h/o passage of frank blood in the urine
• No h/o crying at micturition , yellowish discoloration of
the body
• No h/o any skin infection
• No h/o petechia, purpura.
Contd,,,

5. Family history:
• No h/o similar illness in family
• No h/o consanguineous marriage
• No h/o TB, DM, Kidney deases
• No h/o HTN
Dietary History:
• Tea+ 1 kotori rice+ 1 kotori daal+ 1
kotori potato curry
• Not significant history given by
mother.
Immunization history:
Immunization as per EPI schedule
with strictly all vaccines given to
child
 Developmental History
• H/o normal developments
• Explore drawers, runs ups
and downstairs
• Vertical and circular strokes
• Asks for food , toilets
• 2-3 word sentence, short sentences

6. REVIEW OF SYSTEMS
 General condition:
• facial puffiness +ve
• Edema +ve, bilateral pitting edema of limbs
• No any scar marks of infection
• Pulse: 110/min
• RR: 22/min
• Temp: 98 F
• BP: 90/60 on rt arm in sitting

7. PHYSICAL EXAMINATION
 GIT:
Abdomen distended,
umbilicus central, all
quadrant moving
symmetrically with
respiration, no venous
prominence, no scar
marks, hernia site are
intact.
On palpation: no local rise
in temp
no tenderness
no any lump and organ
On percussion: shifting
dullness present
vesicular
breath
sounds ; no
added sounds,
Trachea
Central
 CVS: S1S2,Mo, No added
sounds.
Preliminary Diagnosis.
Probably a case of
nephrotic syndrome.
Mostly Minimal

8. PHYSICAL
EXAMINATION

9. Parameters Result Reference range
UREA 14mg/dl 10-50
Creatinine 0.2mg/dl 0.5-1.4
Sodium 131 mmol/L 136-145
Potassium 4.1mmol/L 3.5-5.0
Total Protein in
24 hrs urine
360 ml/ 0.27 g/day 1500-2500
<0.15
Serum
cholesterol(Total)
423 mg/dl <200
Serum albumin 2.3 g/dl 3.5-5.3
Urinary
protein
0.51
3.06
<0.2mg/g
Biochemical Parameters

10. Contd….
Urine RE Result
Albumin 4+
Sugar Nil
Microscopic Test
WBCs 2-3/HPF
RBCs 8-10/HPF
Epithelial cells 3-5/HPF
Others not seen.
Urine culture and sensitivity
Sterile after 24 hours.
HBsAg, HCV and HIV negative
Sputum AFB : not seen.

11. Hematological parameters.
Parameters Result Reference
Blood group O positive
CBC
Hemoglobin 12.8 gm/dl 11-16gm/dl
PCV 35.9 36-48%
TLC 9400 4000-11000 cell/mm
cu
Neutrophil 25 40-75 %
Lymphocyte 60 20-45%
Monocyte 06 2-10%
Eosinophil 09 1-6%
Platelet 324000 150000-400000cell/
mm cu
ESR 54 1st hour

12. DIAGNOSIS
• With the clinical sign and symptoms , lab
diagnosis, age as well as other no secondary
diseases associated.
• Nephrotic syndrome with some hematuria. Most
probably minimal change disease nephrotic
syndrome for the confirmation renal biopsy is
preferred.
• Most (>85%) of children MCN.

13. Treatment Given :
 Sryp Ritocef (5/50) 5ml x PO x
BD (cefixime)
 Tab Emsolone 25 mg x PO X
OD (prednisolone)
 Sryp Digene 5ml x PO x BD
(antacid)

14. THANKS!