Dr amany alsherif case

1. CASE PRESENTATION
Amany sherif
Residance of nephrology
NMGH

2. PERSONAL HISTORY
Male patient named Aziz mansour
,55y old from Manzalla ,worker,
gosa smoker with no other special
habits

3. •PAST HISORY
No history of DM or HTN.
No hisoryof HCV or HBV.
No history of SLE or any immunological disease.
History of appendectomy 40 y ago.

4. FAMILY HISTORY
.No family history of HTN or DM
.No family history of kidney disease

5. COMPLAIN
Swelling of both lower limbs.
Swelling of eye lids.

6. PRESENT HISTORY
Patient presented with
*edema of both LL 1 year ago with gradual onset
Progressive corse.
*puffnss of eyelids.
Patient seek medical advice and take non
specific therapy
patient come to our hospital 21_2_2018.
*

7. DRUG HISTORY
Drug history of NSAIDS abuse

8. ON ADMITION
patient was conscious
,orianted
Bp 140/80
Pulse 80 /min regular
Lower limb edema
Puffnes of eyelids
Abdomen : lax not tender
No skin rash
Chest ; normal
Heart ; normal

9. Laboratory investigations
S.cr : 0.8
Urea: 27
K+: 3.6
Na: 142
Alb: 2.7
Hb: 16
WBCs: 7.4
Plt: 232
INR: 0.9

10. URINE ANALYSIS
Protein : +
*
*RBCs : 0-
5
Pus cells : 0-5
*
24 hour urine protein : 6 gm /day.*

11. ANA : -ve
*
C3 :75 normal (90-210).*
Uric acid : 6.1.
*
.

12. U/S
Both kidney :average size (11x6.
Normal shap& position.
Increase echo(grade 1).
Good CMD.
No back pressure.
RT kidney : single cyst in mid pole.
Lt kidney : multiple small stones (gravels).

13. 25/224/223/222/2
6.306.606.306.00WBCs
14.913.314.515.4HB
244196216165PLt
o.70.8o.80.7S.Cr
32342626Urea
136134138138Na
4.24.43.44K
1.010.930.941.02INR
7.447.427.357.40PH
27283534PCO2
18.3182121HCO3

14. FLUID BALANCE
outputIntake
3900240023/2
2000150024/2
3200465025/2

15. DRUG
Tritace 2.5 mg once/day
Lasix 20 mg ½ tab/day
Ator 10 mg once/day

16. /2/201828
Renal biopsy was taken and waiting
for result
We also asked Electropharesis.

18. MEMBRANOUS GLOMERULONEPHRITIS
It is the second most common cause of
nephrotic
syndrome in adult after FSGS.
Causes:
Primary , idiopathic 85%
Secondary:
Autoimmune (SLE)-1
Infection (syphilis- malaria- hepatitis B,C)-2
Tumer of lung ,colon,brest ,kidney.-3
Drugs (NSAIDS- Capotril- penicillamin)-4