48 year old male with pedal edema,abdominal distention and facial puffiness



 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. 

Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. 


This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.

Here is a case i have seen:



A 48 yr old male who is a labourer by occupation in 2019 he had complaints of pedal odema pitting type , abdominal distension and facial puffiness visited many hospitals and certain investigations was done







 in january  renal biopsy was done membranous nephropathy with plar 2+ was diagnosed. 

In February 24 hr urine protein was done (4.7gm/lt) and was on treatment with dytor plus , rosuvastatin, protein powder and metformin and used medication for 3 months till march and stopped

In 2020 april he went to another hospital and his report were 


In july 2020 he was adviced ponticelli regimen but not received

He used telma,atorvastatin, deptir, protein powder till date continuing these medications till date

In nov and dec vistited hospital for routine checkup


c/o thin stream of urine since 6 months with dribbling and break in  the continuity of the stream.

c/o swelling in the epigastric region since 6 months. 

No h/o jaundice,malena,hematemesis,fever,pain abd, vomitings, loose stools etc

No h/o weight loss,loss of appetite.

not a k/c/o DM,HTN,TB,ASTHMA

 

pt has a non veg diet ,normal appetite,normal bowel and bladder movements, adequate sleep.

Drinks alcohol occasionally (once a month)

not a smoker.

GENERAL EXAMINATION: 

Pt is concious, coherent and cooperative

thin built 

orinted to time,place and person

VITALS 

Bp-190/130 mmhg

pulse -82 bpm

spo2-99% ar room air

RR-18 cpm

temp-98 F

SYSTEMIC EXAMINATION:

CNS- NAD

CVS-S1S2 heard, no murmurs

RS- BAE+ ,NVBS







P/A-


Abdomen is soft,non tender and distended

umbilicus - inverted

fluid thrill +

ventral hernias are seen- 2 in number 

 Provisional diagnosis:

Ascites under evaluation with hypoalbunemia

De novo hypertension

INVESTIGATIONS





















                          ECG

                   USG REPORT

                              2D ECHO






DIAGNOSIS- Nephrotic syndrome with tense ascitis with high saag ( portal hypertension) with de novo hypertension

Treatment

  1. 3 egg whites/day 
  2. B protein powder 2 scoops in 1 glass of milk tid
  3. T telma 40 mg po od
  4. Fluid less than 1 litre/day , salt restriction less than 2 g/day
  5. Monitor vitals hourly

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