case report- nephrotic syndrome
TRANSCRIPT
Case reportIntern吳易儒
Basic data
Chart number:45660472Age:22Sex:FemaleEducation:Junior highOccupation:Business(菜市場)
Marital status:Married
Present illness
● CC:Shortness of breath for weeks● G2P1, pregnancy GA 32wk● History:
○ polycystic ovary syndrome○ Termination due to generalized edema
and lower legs twitching(2012/7/17)○ Prednislolone treatment(2013/2/7-6/30)
Present illness● OPD(8/15,1 week before admission):
○ Lower abdominal tightness ○ General edema+ weight gain 5 kg in 2
months○ Orthopnea+PND+DOE since 4wk
gestation○ foamy urine○ Improved by Ritodrine
Present illness
● This time(2 days ago):● Progressive DOE with proteinuria and
decrease urine output● severe hypertension(-), headache(-)
visual abnormalities(-), upper abdominal or epigastric pain(-), N/V(-),mental status change(-).
Social history
Allergy: Kind of painkillerAlcohol drinking: DeniedBetelnut chewing: DeniedCigarette smoking: Denied
Family history
● Grandmother-hypertension● Mother-DM● Aunts-polycystic ovary syndrome
Review of systemsGeneral:Recent weight change:+Fever/Chills:- Change in appetite:- Fatigue:- Generalized weakness:-
Skin:Rashes: -Itching: -Bruising: -Petechiae: -Spider angioma: -Hair loss: -Nail change: -
Review of systemsRespiratory:Lung disease:- Cough:+ Sputum:- Hemoptysis:- Shortness of breath:+ (especially on exertion)Wheezing:-
HEENT:Head trauma: -Blurred vision: -Photophobia: -Hearing impairment: -Tinnitus: -Rhinorrhea: -Gum bleeding: -
Review of systemsCardiovascular:Heart trouble:+ Chest pain:- Dyspnea on exertion:+ Orthopnea:+ Palpitation:- Intermittent claudication:-Varicose veins:- Edema:+
Gastrointestinal:Dysphargia: -Bloating: -Tarry stool: -Constipation: -Diarrhea: -Palpating tenderness: -Jaundice: -
Review of systems
Endocrine:Polyuria or polydipsia:-Thyroid disease:- Heat or cold intolerance:-
Genitourinary:Decrease in urine output:+Nocturnal micturation: -Urinary urgency: -Post-micturation dripping: -Urinary incontinence: -
Musculoskeletal:arthralgia:- Myalgia:- Back pain:-
Neurological:Syncope:- Seizures:- Focal weakness/paralysis:-Numbness/paresthesias:-Tremor:-
Psychiatric:Irritability:- Difficulty concentrating:-Memory loss:- Depression:- Anxiety:- Psychiatric treatment:-
Physical examinationHeight:149 cm; Weight:76.4 kg; Vital signs:T/P/R: 36.3/94/20BP:142/83General Appearance:Consciousness: clear, alert, fair lookingGCS: E4M6V5
Physical examinationHEENT:
Head: normocephalic, no atraumatic lesions
Eye: no cornea without lesion, no pale conjunctiva, no
icteric sclera, equal pupil,2mm,round,reactive to light
Physical examinationEars:normal appearance, no obvious hearing loss
Nose:no nasal discharge, no deformity, no sinus tenderness
Mouth & throat: no lips cyanosis, no pallor lips
Physical examinationNeck: Supple
no evidence of tracheal deviation, no jugular venous
engorgement,no lymphadenopathy, normal thyroid size,
no palpable thyroid nodules
Heart:Regular heart beats withouth murmur
Physical examinationChest:Symmetric expansion
No focal tendernessNo chest wall lesionBS: crackles over bilateral lower lung
Abdomen:Soft, no focal tendernessLiver and spleen: not palpableBowel sound: normally activeCV angle: no knocking pain
Physical examinationSkin:No cyanosisNo focal erythemaExtremities:bilateral leg edema,2+Free movement with full ROMNo clubbing fingerNeurological:No flapping tremor, Muscle power: full
Initial lab data
Initial lab data
Renal echo 2014/8/221. Kidney Size ( cm ) Right : Normal 10.35 x 1.55 cm Left : Normal 10.81 x 1.56 cm 2. Kidney Outline Right : Smooth Left : Smooth 3. Cortical echogenecity Right Cortical echogenecity : Normal Left Cortical echogenecity : Normal
Renal echo 2014/8/224.Central sinus area Right Central sinus area : Dilatation Left Central sinus area : NormalUltrasound Diagnosis Right mild pelviectasis
Heart echo 2014/8/22Ventricles.Normal sizes of ventricular chambers..LVEF by M-mode is 61.7 %..Mitral inflow: E/A ratio 1-2..Deceleration time of mitral inflow 0.22 sec..Isovolemic relaxation time is 0.05 sec..Lateral E' : 10 cm/s.
Heart echo 2014/8/22Valves.MR jet area is <20% of LA area..TR jet area is <20% of RA area..Estimated systolic pulmonary artery pressure is 22 mmHg.
Chest echo 2014/8/22Clinical Diagnosis : dsypneaUltrasound Findings : Effusion : Bilateral free of pleural effusionUltrasound Diagnosis : Bilateral free of pleural effusion
Termination
Diagnosis
Proteinuria
Nephrotic syndrome during pregnancy
Pulmonary edema improved
Treatment
Lasix supplementAlbumin supplement
ReviewNephrotic syndrome in pregnancy
Thanks for your attention