NEPHROTIC SYNDROME WITH TYPE -I DM, HYPERTENSION,RIGHT PLEURAL EFFUSION
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I have been given this case to solve in an attempt to understand the topic of patient clinical data analysis to develop my competency in reading and comprehending clinical data including histoty, clinical findings, .investigations and come up with a diagnosis and treatment plan.
A 20 yrs old female who is a house wife was brought to the casualty on 23/10/2022 with the features of
• Bilateral pedal edema since 1 months
•Shortness of breath (grade 2-3 ) since 1 months,which is insidious on onset gradually progressive not associated with orthopnea
•Decreased urine output since 10 days
•Swelling of lips since 3 days
HOPI:-
Patient was apparently asymptomatic 11years ago,then her parents observed her eating more food, increased urine output on a regular check up she was diagnosed with diabetes type -1(On insulin since then)
2018- Patient became drowsy and brought to the hospital , diagnosed with DKA
From then she is on MIXTARD 18UNITS MORNING,12UNITS NIGHT
•1 year ago ,she got married
• 6 months ago- She was brought to the hospital as she has Fever , Not eating food for 5 days.Then she was diagnosed Hypertensive ,since then she is on Telma 40 mg
•3 Months Ago , patient was diagnosed with Urine pregnancy test positive and had abortion 2 months ago as fetal cardiac activity is absent
• Patient was brought to hospital as she has
pedal edema since 3 months, Pitting type
•Shortness of breath (grade 2-3 ) since 3 months,not associated with orthopnea /PND
•Decreased urine output since 10 days
•Swelling of lips since 3 days
FAMILY HISTORY:
Maternal uncle's have DM-2
GENERAL EXAMINATION:
Pt is conscious, coherent, cooperative
Bp-150/90 mmHg
Pr-91bpm
Temp -98.5°F
SpO2- 91%
GRBS -254mg%
CVS : S1 S2 +, Apex beat : 5th ICS mid clavicular line.
RS : BAE +, Decreased breath sounds in Right infra axillary,midscapular ,infrascapular regions,No crepts
CNS : NAD
P/A : Soft, no tenderness . Bowel sounds +
Pallor ++,Edema present in both limbs ,face ,abdomen
No icterus, cyanosis, clubbing or lymphadenopathy
PROVISIONAL DIAGNOSIS:
NEPHROTIC SYNDROME WITH TYPE -I DM(since 11yrs) RIGHT PLEURAL EFFUSION
INVESTIGATIONS
RBS - 260mg/dl
SERUM IRON-95 ug/dl
Reticulocyte count -0.7%
BLOOD GROUPING AND TYPE:- O POSITIVE
PERIPHERAL SMEAR:
RBC : Mild Anisocytosis with Microcytic Hypochromic Cells few Normocytes seen
WBC : With in normal limits
PLATELET : Adequate
