Puffy

Renal & Urinary System


0

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P3_F1.jpg"}},{"insert":"\n\n"},{"insert":"The clinic door opens, letting your next patient in.\n\nYou are pleasantly surprised to see Gabriela, a normally bubbly seven-year-old who goes to school with your daughter. She is accompanied by her mother, Mrs. Morales.\n\n\u0022Hi, doctor! My legs are real thick. I don\u0027t like them, they\u0027re not pretty anymore\u0022, says the little girl sulkily.\n\nHer mother explains - \u0022Her legs began to swell around a week ago. It was barely noticeable at first and I didn\u0027t think much of it, but it seems to have gotten much worse now.\u0022\n"}]}

1

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P3_F2.jpg"}},{"insert":"\n\n"},{"insert":"Gabriela is 123 cm tall (82nd centile) and weighs 26 kg (77th centile).\n\nThere was no history of fever or joint pain. Her medical history is unremarkable, save for \u0022colds once or twice a year\u0022, and she is currently not on any medications.\n\nOn examination, her blood pressure is 110\/70 mmHg, while her heart rate is 78 bpm. You find no rashes on her face or elsewhere, and the abdominal exam is unremarkable.\n \nHer lower limbs demonstrate a symmetrical, pitting edema.\n"}]}

2

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P3_F3.jpg"}},{"insert":"\n\n"},{"insert":"You request several investigations, of which the results are as follows:\n\nHb: 12.6 g\/dL (11.5-15.5)\nHct: 38% (35-45)\nWBC: 10,900 \/mm3 (5,000-14,500)\n Neutrophils: 66% Lymphocytes: 31%\nPlt: 200,000\/mm3 (150,000 - 450,000)\n\nSerum Creatinine: 0.65 mg\/dL (0.0-0.7 mg\/dL)\nSerum Albumin: 18 g\/L (35-55)\nUrinalysis: 3+ proteinuria; no hematuria or cell casts.\n\nIt is now clear that Gabriela has nephrotic syndrome. You admit her to your ward for treatment and monitoring.\n"}]}

3

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P3_F4.jpg"}},{"insert":"\n\n"},{"insert":"Following admission, you order a morning urine sample for proteins and creatinine (which is 2.5 mg\/mg) and a 24-hour urine protein (later found to be 6.2g), which confirm your diagnosis.\n\nYou also start investigating Gabriela for secondary causes of nephrotic syndrome, and recommend a low-sodium diet, and water restriction.\n\nAt this point, you are interrupted by a very anxious Mrs. Morales.\n\n\u0022\u00a1Dios M\u00edo, doctor! My friend Miriam\u0027s brother had this too, and they had to take out part of his kidney for a test. Will you do the same to Gabriela?\u0022\n\n\u0022Calm down, Mrs. Morales. Are you talking about a renal biopsy?\u0022, you ask.\n\n\u0022Yes, yes! That\u0027s the one\u0022, she replies.\n"}]}

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