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WELCOME Med Pro Clinic’s Fall Seminar Day 5

WELCOME Med Pro Clinic’s Fall Seminar Day 5. Case Report #23. Patient 32 year-old male “Bloated feeling” Swelling of the face, feet, and ankles Discomfort around the abdominal area Malaise. Patient Swelling moved from his face (in the morning) to his feet (at bedtime) Weight gain

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WELCOME Med Pro Clinic’s Fall Seminar Day 5

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  1. WELCOMEMedProClinic’sFall SeminarDay 5

  2. Case Report #23 • Patient • 32 year-old male • “Bloated feeling” • Swelling of the face, feet, and ankles • Discomfort around the abdominal area • Malaise

  3. Patient • Swelling moved from his face (in the morning) to his feet (at bedtime) • Weight gain • Loss of appetite • Urinating less frequently • Denied: • Hematuria • Blurred vision • Allergies • Joint pain • Cough • Hemoptysis

  4. Patient • No history of diabetes • No history of previous oliguria • No family history of diabetes • No family history of kidney disease • Malaria • Africa and India

  5. Physical Examination • Edema • Eyes • Face • Extremities • Abdomen • Scrotum

  6. Laboratory Findings • Temperature taken: 99.1 °F • Weight: 214 lbs • Heart rate: 75 BPM • Blood pressure recorded as: 145/92

  7. Laboratory Findings • Urinalysis • foamy appearance • marked proteinuria – 10.3 mg/dl • SSA – 3+ • HDL3 lost into urine • specific gravity – 1.047 • Microscopic: • fatty casts – rare • Hyaline casts – rare

  8. Laboratory Findings • 24-hour Urinalysis • Total protein – 4.5 g • Albumin – 3.2 g

  9. Laboratory Findings • Blood Tests • Albumin – 2.5 g/dl • Cholesterol – 400 mg/dl • Due to hepatic overproduction of VLDL • Triglycerides – 220 mg/dl • Total protein – 5.8 g/dl • A/G ratio – 0.76

  10. Differential Diagnosis • Anti-nuclear antibody test (serum) • Negative • Glomerular basement membrane antibody test (serum) • Negative • Ruled out • Systemic Lupus Erythematosus • Lupus Erythematosus • Good Pasture’s Syndrome

  11. Diagnosis Nephrotic Syndrome

  12. Prognosis • Remission • Spontaneous remission

  13. Treatment • Prescribed • ACEI angiotensin-converting enzyme inhibitor • (to reduce protein loss in the urine) • Instructions reduce dietary sodium intake

  14. Follow Up • 10 days later • No edema • Weighing 203 lbs • Normal frequency of urination • Return of appetite

  15. Current Research • Molecular/genetic causes of Idiopathic Nephrotic Syndrome • Children unresponsive to steroid therapy • Most likely develop end-stage renal disease • Current theory • T cells produce permeability factor that affects glomerulus filtration • Disruption of normal podocyte (glomerular epithelial cell) function leads to • Proteinuria

  16. Current Research (continued) • Relationship • Elevated IgE serum levels and Nephrotic Syndrome • Conclusion • Higher IgE levels seem associated with poor result

  17. Quick Quiz • The physical presentation of Nephrotic Syndrome included which of the following: • edema • jaundice • frizzy hair • skin lesions

  18. Quick Quiz • The urinalysis dipstick test revealed obvious increase in: • sperm • glucose • Urobilinogen • protein

  19. Quick Quiz • Oliguria means: • Frequent urination • Scanty urination • No urination • Blood in urine

  20. Quick Quiz • The group of laboratory findings/symptoms that are characteristic of Nephrotic Syndrome are: • bacteremia, elevated blood glucose, >30 WBCs/hpf microscopic, anorexia • ketones in urine, renal epithelial cells present in microscopic • urobilinogen postive dipstick, 3.2 pH level, increased serum albumin levels, hair loss • proteinuria, edema in the face and extremities, decreased serum albumin, and increased cholesterol

  21. Quick Quiz • Nephrotic Syndrome can be defined as (select all correct answers): • Disease or group of diseases that affect the permeability of the glomerulus • Disease that causes inflammation of the kidneys • Disease with signs/symptoms including proteinuria, hypoalbuminemia, edema, and hyperlipidemia

  22. Thank You for Attending

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