A young boy aged 13 years p/w complaints of Gradual onset decreased Urine output and Generalised Edema more below the eyes since 2-3 months....No history of Fever or any drug intake is present...At presentation, he was found to have Anasarca and b/l pleural effusion and ascites...his reports are displayed....determine the treatment approach to this patient and how shd he be treated...

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Apparently looks like a case of nephrotic syndrome. Investigations required are 1 24 hours urinary protein more than 3.5 gms is diagnostic 2.Serum Protein levels , A hypoalbuminemia less than 2.5 GM/dL will be seen 3.Hyperlipdaemia may be present 4.Creatinine clearance test 5.Increased lipiduria and ESR 6.Decreased levels of anti thrombin 3 7 A kidney biopsy may be required Rule out CCF and hepatic cause of these symptoms Treatment- Medical nutrition therapy with high proteins Diuretics - furosemide Vitamin D and calcium supplements

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Urine routine exam Urine for albumin and 24hrs urine for protuenuria..,LFT . This ought to have been the first investigation Looks like Nephrotic Syndrome.

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Dd may be 1 nephrotic syndrome 2 may SLE Lupus nephritis with polyserositis Check for Ana ,dsdna ,24 hr urinary protein Complete Lft with albumin and globulin total protein , complement levels ,echo ,cbc Present go for mild diuretic with high protein diet Sos steriods according to reports

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Congestive symptoms because of cardiac cause Need 2 D echo Differntials are Congenital or Rheumatic heart disease Severe MS,MR,VSD Hypothyroidism Pericardial effusion

SEEMS TO BE PERICARDIAL EFFUSION WITH C H F ADV 1 ECHOCARDIOGRAPHY 2 TAPPING OF PERICARDIAL FLUID CELLS = NO ,TYPE PROTEIN ,LDH, . . ADA 3 MANTOUX TEST ...4 24 HOURS URINE PROTEIN TO EXCLUDE NEPHROTIC SYNDROME 5 BLOOD PROTEIN LFT RX SALT & FLUID RESTN DIURETIC ..... TILL CAUSE IS ESTABLISHED

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Yes he looks to be a c/o nephrotic syndrome with progressing to CCF with polyserocytis as usg and cect abd and xray chest are suggestive agreed with dr Sangeetha Swaminathan for Lfts 24urine albuminurea and routine . How is his vitals are as there is cardiomegaly so evaluate for cardiac functions ecg 2decho .Rx to start with diuretics only and than steroids

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Seems to be a case of nephrotic syndrome. Advised urine examination. 24hours urine proteins. X-ray chest, MX test, S. Cholesterol.

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Anasarca with onset of edema from.peri orbital area...... strongly suggestive of nephrotic syndrome. Plz.get urine Routine examination, 24 hours urine protein estimation, serum albumin, lipid profile. If turn out to be nephrotic...... start on steroid. do ANA, C3/C4, HIV, HbsAg, Anti HCV. Eventually will need renal biopsy

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Hypoprotinemic edema, ascites, pleuropericardial effusion. What is serum proteins value, including LFT.

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