case report- nephrotic syndrome

Case reportIntern吳易儒

Basic data

Chart number:45660472Age:22Sex:FemaleEducation:Junior highOccupation:Business（菜市場）

Marital status:Married

Present illness

● CC:Shortness of breath for weeks● G2P1, pregnancy GA 32wk● History:

○ polycystic ovary syndrome○ Termination due to generalized edema

and lower legs twitching(2012/7/17)○ Prednislolone treatment(2013/2/7-6/30)

Present illness● OPD(8/15,1 week before admission):

○ Lower abdominal tightness ○ General edema+ weight gain 5 kg in 2

months○ Orthopnea+PND+DOE since 4wk

gestation○ foamy urine○ Improved by Ritodrine

Present illness

● This time(2 days ago):● Progressive DOE with proteinuria and

decrease urine output● severe hypertension(-), headache(-)

visual abnormalities(-), upper abdominal or epigastric pain(-), N/V(-),mental status change(-).

Social history

Allergy: Kind of painkillerAlcohol drinking: DeniedBetelnut chewing: DeniedCigarette smoking: Denied

Family history

● Grandmother-hypertension● Mother-DM● Aunts-polycystic ovary syndrome

Review of systemsGeneral：Recent weight change：+Fever/Chills：-　Change in appetite：-　Fatigue：-　Generalized weakness：-　　

Skin：Rashes: -Itching: -Bruising: -Petechiae: -Spider angioma: -Hair loss: -Nail change: -

Review of systemsRespiratory：Lung disease：-　Cough：+　Sputum：-　Hemoptysis：-　Shortness of breath：+ (especially on exertion)Wheezing：-

HEENT：Head trauma: -Blurred vision: -Photophobia: -Hearing impairment: -Tinnitus: -Rhinorrhea: -Gum bleeding: -

Review of systemsCardiovascular：Heart trouble：+　Chest pain：-　Dyspnea on exertion：+　Orthopnea：+　Palpitation：-　Intermittent claudication：-Varicose veins：- Edema：+

Gastrointestinal：Dysphargia: -Bloating: -Tarry stool: -Constipation: -Diarrhea: -Palpating tenderness: -Jaundice: -

Review of systems

Endocrine：Polyuria or polydipsia：-Thyroid disease：-　Heat or cold intolerance：-

Genitourinary：Decrease in urine output:+Nocturnal micturation: -Urinary urgency: -Post-micturation dripping: -Urinary incontinence: -

Musculoskeletal：arthralgia：- Myalgia：- Back pain：-

Neurological：Syncope：-　Seizures：-　Focal weakness/paralysis：-Numbness/paresthesias：-Tremor：-　　

Psychiatric：Irritability：-　Difficulty concentrating：-Memory loss：-　Depression：-　Anxiety：-　Psychiatric treatment：-

Physical examinationHeight：149 cm;　Weight：76.4 kg;　Vital signs:T/P/R: 36.3/94/20BP:142/83General Appearance：Consciousness: clear, alert, fair lookingGCS: E4M6V5

Physical examinationHEENT:

Head: normocephalic, no atraumatic lesions

Eye: no cornea without lesion, no pale conjunctiva, no

icteric sclera, equal pupil,2mm,round,reactive to light

Physical examinationEars:normal appearance, no obvious hearing loss

Nose:no nasal discharge, no deformity, no sinus tenderness

Mouth & throat: no lips cyanosis, no pallor lips

Physical examinationNeck: Supple

no evidence of tracheal deviation, no jugular venous

engorgement,no lymphadenopathy, normal thyroid size,

no palpable thyroid nodules

Heart：Regular heart beats withouth murmur

Physical examinationChest：Symmetric expansion

No focal tendernessNo chest wall lesionBS: crackles over bilateral lower lung

Abdomen：Soft, no focal tendernessLiver and spleen: not palpableBowel sound: normally activeCV angle: no knocking pain

Physical examinationSkin：No cyanosisNo focal erythemaExtremities：bilateral leg edema,2+Free movement with full ROMNo clubbing fingerNeurological：No flapping tremor, Muscle power: full

Initial lab data

Initial lab data

Renal echo 2014/8/221. Kidney Size ( cm ) Right : Normal 10.35 x 1.55 cm Left : Normal 10.81 x 1.56 cm 2. Kidney Outline Right : Smooth Left : Smooth 3. Cortical echogenecity Right Cortical echogenecity : Normal Left Cortical echogenecity : Normal

Renal echo 2014/8/224.Central sinus area Right Central sinus area : Dilatation Left Central sinus area : NormalUltrasound Diagnosis Right mild pelviectasis

Heart echo 2014/8/22Ventricles.Normal sizes of ventricular chambers..LVEF by M-mode is 61.7 %..Mitral inflow: E/A ratio 1-2..Deceleration time of mitral inflow 0.22 sec..Isovolemic relaxation time is 0.05 sec..Lateral E' : 10 cm/s.

Heart echo 2014/8/22Valves.MR jet area is <20% of LA area..TR jet area is <20% of RA area..Estimated systolic pulmonary artery pressure is 22 mmHg.

Chest echo 2014/8/22Clinical Diagnosis : dsypneaUltrasound Findings : Effusion : Bilateral free of pleural effusionUltrasound Diagnosis : Bilateral free of pleural effusion

Termination

Diagnosis

Proteinuria

Nephrotic syndrome during pregnancy

Pulmonary edema improved

Treatment

Lasix supplementAlbumin supplement

ReviewNephrotic syndrome in pregnancy

Thanks for your attention