21 year old with Generalised Anasarca

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A 15 year old girl presented to the opd today with the complaints of
Bilateral lower limb swelling since 15 days
Reduced urine output since 10 days 
Abdominal distension since 5 days
Facial puffiness since 3 days
Dyspnea at rest since 3 days
Non productive cough since 3 days 
Fever since 1 day

She was born out of a 3rd degree consanguinous marriage. She has 2 healthy  siblings. Her father expired when she was 10 years old, he was a chronic alcoholic,  according to her mother who is unsure regarding the cause of his death, she attributes it to ? Respiratory Failure and Liver failure . 
According to her mother, her father's elder sister had a kidney disease due to which she expired. 

When she was 6 years old - she experienced cough along with dyspnea and low grade fever after which she was diagnosed to have pulmonary kochs for which she used ATT for 6 months. 

Her mother works as a daily wage laborer.

She finished her 8th grade, she as well is currently working as a daily wage laborer along with her mother.  

At 15 years of age - she attained menarche 

15 days back she developed bilateral lower limb swelling extending upto her thighs.

She later developed a cystic  lesion near her vagina which burst after she got it excised in a local hospital after which there was a serous discharge. 

10 days back she developed reduced urine output following which she developed
Abdominal distension since 5 days after which she developed
Facial puffiness, dyspnea at rest at 3 days along with non productive cough since 3 days

With these complaints she visited a hospital in Hyderabad where in she was told to have a kidney problem

On 4/10/2021
Her weight on 4/10/2021 was 55kg 

Her serum creatinine was 1.3g/dl
Urine showed albuminuria 4+
Along with 4-6 rbcs and 10 - 12 pus cells, 2 - 4 epithelial cells 
Her spot protein creatinine ratio was more than 7.2
Her spot urine creatinine was 150mg/dl
Spot urine protein was 940mg/dl
Her USG abdomen   revealed bilateral pleural effusion 
And showed raised echogenecity of Kidneys 
Ascites 

She was prescribed Tab Lasilactone 20/50 BD 
Along with Tab Omnocortil 60mg OD
Tab Metolazone 2.5mg OD which she took for 3 days 

She also has been experiencing low grade fever since yesterday night.



On examination:
Mild erythematous rash on her cheeks +
Pallor was present along with bilateral lower limb edema

RR - 26cpm
PR -102bpm
BP- 120/80mmhg
Afebrile
Abdominal - 
Distended 
Bowel sounds +
Lungs - 
Inspiratory crepts in bilateral IAA,ISA
Cvs - S1,S2+

Diagnosis -
Nephrotic syndrome

Investigations done at our hospital:
7/10/2021

Hb - 10.9 gm/dl
TLC - 9100 cells/cumm
Platelets - 2.54 Lakhs /cumm 
MCV - 76.6
MCHC - 35.5


Peripheral smear - Normocytic normochormic 

Her blood urea here today is 206mg/dl
Serum creatinine of 2.1mg/dl
Serum albumin of 1.8mg/dl


Complete Urine Microscopy:

Showing Granular casts

Showing dysmorphic RBCs

Showing 4+ Albuminuria, 8- 10 dysmorphic rbcs, 10-12 pus cells, epithelial cells 12-14 cells/HPF






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