65 YR OLD MALE WITH FACIAL PUFFINESS AMD SWELLING OF BOTH LOWER LIMBS

202422234
CASE HISTORY AND CLINICAL FINDINGS
CHIEF COMPLAINTS:
C/O FACIAL PUFFINESS SINCE 5 MONTHS
C/O BILATERAL SWELLING OF LOWER LIMBS SINCE 5 MONTHS.
HOPI:
PATIENT WAS APPARENTLY ASYMPTOMATIC 5 MONTHS AGO THEN DEVELOPED FACIAL
PUFFINESS WHICH WAS INSIDIOUS , ON AND OFF .ONLY IN MORNING , GRADUALLY
DECREASED BY NIGHT FOLLOWED BY PEDAL EDEMA, IN BOTH LEGS EXTENDS UPTO
MIDTHIGH, PITTING TYPE, GRADUALLY PROGRESSIVE.
H/O SOB CLASS 2 NYHA, ABDOMINAL DISTENSION , SWELLING OF BOTH HANDS.
NO H/O DECREASED URINE OUTPUT ,FEVER
NO H/O CHEST PAIN, PALPITATIONS
NO H/O COUGH,COLD,CONSTIPATION
NO H/O RASH,ITCHING
PAST HISTORY -
K/C/O NEPHROTIC SYNDROME SECONDARY TO MEMBRANOUS NEPHROPATHY
(SEROLOGICAL DIAGNOSIS )SINCE 1 YEAR 3 CYCLES OF MODIFIED PONTICELLI REGIMEN
WAS GIVEN AND ON REGULAR MEDICATION
K/C/O HTN SINCE 2 YEARS WAS ON TAB .CLONIDINE 0.1MG PO/BD,TAB CINOD 10 MG PO/BD
,TAB METXL 25MG PO/BD
K/C/O DM SINCE 2 YEARS WAS ON TAB.LINAGLLIPTIN 5MG PO/OD
N/K/C/O EPILEPSY,THYROID DISORDERS,CVA,CAD,ASTHMA,TB
GENERAL EXAMINATION:
PATIENT IS CONSCIOUS COHERENT COOPERATIVE
NO PALLOR,ICTERUS,CYANOSIS,CLUBBING, PEDEAL EDEMA PRESENT ON BOTH LOWER
LIMBS
VITALS:
BP :130/80MM HG
PR : 88BPM
RR: 18CPM
SPO2: 98% AT RA
TEMP: 96 F
CVS : S1S2 +,NO MURMURS
RS: BAE+, NO ADDED SOUNDS
CNS : NFND
P/A: SOFT, NO DISTENSION
NEPHROLOGIST OPINION I/V/O NEPHROTIC SYNDROME:
ADV -T.WYSOLONE 5MG PO/OD
T.MET-XL-50MG PO/OD
TAB.TELMA-40MG PO/OD
TAB.MYCOPHENOLATE 500MG PO/OD
OPHTHALMOLOGY REFERRAL I/V/O DIABETIC RETINOPATHY CHANGES:
ADV-NORMAL FUNDUS STUDY
NO RETINOPATHY CHANGES
COURSE IN THE HOSPITAL
65Y TEAR OLD MALE CAME WITH COMPLAINTS OF GENERALISED SWELLINGS OF
LOWERLIMBS ,UPPER LIMBS,FACE ,ABDOMINAL DISTENSION .ON FURTHER HISTORY
TAKING PT WAS DIAGNOSED TO HAVE NEPHROTIC SYNDROME SECONDARY TO
MEMBRANOUS NEPHROPATHY (SEROLOGICAL DIAGNOSIS ,SERUM PLA2R +)MODIFIED
PONTICELLI REGIMEN WAS STARTED IN JULY 2023 AND 3 CYCLES WERE GIVEN ,BUT
PATIENT DISCONTINUED FOLLOW UP SINCE MARCH AND ON IRREGULAR MEDICATION .ON
FURTHER INVESTIGATIONS PT WAS FOUND TO HAVE PROTEINURIA .NEPHROLOGY
OPINION WAS TAKEN AND ADVISED T.WYSOLONE 5MG PO/OD,T.MET-XL-50MG
PO/OD,TAB.TELMA-40MG PO/OD,TAB.MYCOPHENOLATE 500MG PO/OD. BIOPSY COULDN'T
BE PERFORMED DUETO PRESENCE OF RENAL CYSTS .
PATIENT VITALS ARE STABLE AT THE TIME DISCHARGE
INVESTIGATION
NameValueRangeNameValueRangeRFT 21-05-2024 03:53:PM UREA37 mg/dl50-17
mg/dlCREATININE1.5 mg/dl1.3-0.8 mg/dlURIC ACID4.2 mmol/L7.2-3.5 mmol/LCALCIUM9.7
mg/dl10.2-8.6 mg/dlPHOSPHOROUS3.4 mg/dl4.5-2.5 mg/dlSODIUM139 mmol/L145-136
mmol/LPOTASSIUM4.4 mmol/L.5.1-3.5 mmol/L.CHLORIDE104 mmol/L98-107 mmol/LLIVER
FUNCTION TEST (LFT) 21-05-2024 03:53:PM Total Bilurubin0.82 mg/dl1-0 mg/dlDirect Bilurubin0.20
mg/dl0.2-0.0 mg/dlSGOT(AST)20 IU/L35-0 IU/LSGPT(ALT)17 IU/L45-0 IU/LALKALINE
PHOSPHATASE109 IU/L119-56 IU/LTOTAL PROTEINS3.0 gm/dl8.3-6.4 gm/dlALBUMIN1.0
gm/dl4.6-3.2 gm/dlA/G RATIO0.50HBsAg-RAPID21-05-2024 03:53:PMNegative Anti HCV Antibodies
- RAPID21-05-2024 03:53:PMNon Reactive COMPLETE URINE EXAMINATION (CUE) 21-05-2024
03:53:PM COLOURPale
yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMIN++++SUGARNilBILE
SALTSNilBILE PIGMENTSNilPUS CELLS2-4EPITHELIAL CELLS2-3RED BLOOD
CELLSNilCRYSTALSNilCASTSNilAMORPHOUS DEPOSITSAbsentOTHERSNilABG 21-05-2024
10:48:PM PH7.43PCO228.9PO292.0HCO319.1St.HCO321.3BEB-3.7BEecf-4.4TCO238.8O2
Sat96.0O2 Count15.1T3, T4, TSH 21-05-2024 11:04:PM T30.38 ng/ml1.87-0.87 ng/mlT46.39 micro
g/dl12.23-6.32 micro g/dlTSH19.24 micro Iu/ml5.36-0.34 micro Iu/mlRFT 22-05-2024 08:21:PM
UREA31 mg/dl50-17 mg/dlCREATININE1.4 mg/dl1.3-0.8 mg/dlURIC ACID4.4 mmol/L7.2-3.5
mmol/LCALCIUM9.8 mg/dl10.2-8.6 mg/dlPHOSPHOROUS3.9 mg/dl4.5-2.5 mg/dlSODIUM141
mmol/L145-136 mmol/LPOTASSIUM4.6 mmol/L.5.1-3.5 mmol/L.CHLORIDE104 mmol/L98-107
mmol/L
HEMOGRAM:
HB-9.5
TLC-5400
PLT-2.5
RBC-3.33
HBA1C-6.9
FBS-84
22/5/24-
SPOT URINE PROTEIN -720
SPOT URINE CREATININE -119.2
SPOT UPCR -6.0
25/5/24-
24 HR URINE PROTEIN -2280
24HR URINE CREATININE -0.85
24 HR UPCR-2.68
2D ECHO:
TRIVIAL TR/AR/MR
NO RWMA.NO AS/MS. SCLEROTIC AV
GOOD LV SYSTOLIC FUNCTION.GRADE 1 DIASTOLIC DYSFUNCTION.
NO PAH/LV CLOT
USG:
RAISED ECHOGENECITY IN B/L KIDNEYS
B/L RENAL CORTICAL CYSTS.
MODERATE ASCITES
DIAGNOSIS
NEPHROTIC SYNDROME SECONDARY TO MEMBRANOUS NEPHROPATHY.
HYPERTENSION SINCE 2 YEARS
DIABETES MELLITUS SINCE 2 YEARS.
TREATMENT GIVEN
FLUID RESTRICTION <1.5L/DAY
SALT RESTRICTION <2GM/DAY
INJ.MONOCEF 1GM IV BD
INJ PAN 40MG IV OD
INJ LASIX 4OMG IV TID
TAB CLONIDINE 0.1MG PO OD
TAB WYSOLONE 5MG PO/OD
TAB MYCOPHENOLATE MOFETIL 500MG OD
TAB.TELMA 40MG PO OD
TAB MET XL 50G PO OD
TAB LINAGLIPTIN PO OD
ADVICE AT DISCHARGE
FLUID RESTRICTION <1.5L/DAY X CONTINUE
SALT RESTRICTION <2GM/DAY X CONTINUE
TAB WYSOLONE 5MG PO/OD X CONTINUE
TAB MYCOPHENOLATE MOFETIL 500MG PO/OD X CONTINUE
TAB MET XL 50G PO OD X CONTINUE
TAB.TELMA 40MG PO OD X CONTINUE
TAB APIXABAN 2.5MG PO/BD X CONTINUE
TAB ATORVASTATIN 10 MG PO/HS X CONTINUE
TAB LINAGLIPTIN 5MG PO OD X CONTINUE

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