| Nephrotic Syndrome with Nephritis |
| CC: He is swollen |
| HPI/ROS: This 5 6/12 year-old boy had a URI 3 weeks ago and developed otitis media. He was treated with an oral antibiotic. He did not seem to improve so another antibiotic was offered. He began having swelling about the eyes 5 days ago and an antihistamine was offered. The swelling persisted and extended to his face, abdomen, and legs. He felt bad, and lost his appetite. He had crampy abdominal pains and some loose stools (without blood). He had no rash or arthralgia. |
| PFSH: No family history of allergic or other diseases |
| PE: BP 148/92 HR 133 Temp 37 RR 33 |
| ++ periorbital and pretibial pitting edema, + ascites and fluid wave |
| decreased basilar breath sounds prominent 2nd component of S2 |
| No rash, joints normal |
| LABS: Na 128 K 5.6 CO2 17 Cl 93 BUN 88 Cr 4.2 Alb 1.8 |
| UA +++ Bld ++++ Alb pH 6 SpGr 1.015 PTH 160 |
| Chol 330 ANA neg C3 complement 22 |
| COURSE: Hemodialysis is offered for 5 days Renal Biopsy done |
| Spontaneous recovery of urine output, creatinine recovers to 0.5 |
| Heavy proteinuria persists and prednisone / ACE-I are started |
| Some improvement in proteinuria after one month |
|
|
|
|