WELCOME Med Pro Clinic’s Fall Seminar Day 5

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

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

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

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

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

21. 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

22. 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

23. Thank You for Attending