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MedPro 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

• Loss of appetite

– Urinating less frequently – Denied:

• Hematuria

• Blurred vision

• Allergies

• Joint pain

• Cough

• Hemoptysis

• 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

Physical Examination

• Edema – Eyes– Face– Extremities – Abdomen – Scrotum

Laboratory Findings

• Temperature taken: 99.1 °F

• Weight: 214 lbs

• Heart rate: 75 BPM

• Blood pressure recorded as: 145/92

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

Laboratory Findings

• 24-hour Urinalysis– Total protein – 4.5 g– Albumin – 3.2 g

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

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

Diagnosis

Prognosis

• Remission

• Spontaneous remission

Treatment

• Prescribed– ACEI angiotensin-converting enzyme inhibitor

• (to reduce protein loss in the urine)

– Instructions reduce dietary sodium intake

Follow Up

• 10 days later

• No edema

• Weighing 203 lbs

• Normal frequency of urination

• Return of appetite

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

Current Research (continued)

• Relationship – Elevated IgE serum levels and Nephrotic

Syndrome

• Conclusion – Higher IgE levels seem associated with poor

result

Quick Quiz

1. The physical presentation of Nephrotic Syndrome included which of the following:

A. edemaB. jaundiceC. frizzy hairD. skin lesions

Quick Quiz

2. The urinalysis dipstick test revealed obvious increase in:

A. sperm

B. glucose

C. Urobilinogen

D. protein

Quick Quiz

3. Oliguria means:

A. Frequent urination

B. Scanty urination

C. No urination

D. Blood in urine

Quick Quiz

4. The group of laboratory findings/symptoms that are characteristic of Nephrotic Syndrome are:

A. bacteremia, elevated blood glucose, >30 WBCs/hpf microscopic, anorexia

B. ketones in urine, renal epithelial cells present in microscopic

C. urobilinogen postive dipstick, 3.2 pH level, increased serum albumin levels, hair loss

D. proteinuria, edema in the face and extremities, decreased serum albumin, and increased cholesterol

Quick Quiz

5. Nephrotic Syndrome can be defined as (select all correct answers):

A. Disease or group of diseases that affect the permeability of the glomerulus

B. Disease that causes inflammation of the kidneysC. Disease with signs/symptoms including

proteinuria, hypoalbuminemia, edema, and hyperlipidemia

Thank You for Attending