Question

A 4 y/o white male presents with generalized edema and abdominal distention producing respiratory difficulties.

HPI. the child had a URI two weeks ago

PE. Normotensive with facial pitting edema, free ascitic fluid in the peritoneal cavity that is shifting. Fundoscopic exam was normal.

Labs. UA: 4+ proteinemia, hypoalbuminemia, hypercholesterolemia, hypertriglyceridemia with decreased serum ionic calcium. Moderately elevated BUN and Creatinine. Normal complement.

Gross pathology: Kidneys slightly enlarged, elevated, and yellowish,

Imaging: N/A

Micropathophysiology: Nothing of significance, normal renal biopsy (no evidence of immune complex depositions).

2) Please provide a short term managerial protocol for this patient.

Answer 1

2) The child's lab values Protenemia, hypercholesterolemia, edema, and hypoalbuminemia shows symptoms of the Nephrotic syndrome. Moreover, the onset of nephrotic syndrome is more frequent with the history of respiratory infection.

• Hypoalbuminemia is due to increased glomerular permeability and protein loss in the urine.  
• Edema occurs due to increased osmotic pressure in the interstitial fluid.
• Hypercholesterolemia is due to increased production of lipoproteins by the liver to compensate the protein loss.

Assessment:

• Assess for swelling and periorbital edema, scrotal edema.
• Assess the waist level to detect for the ascites.
• Assess the skin for any pale, stretched, and taut.
• Assess for the symptoms of ascites such as anorexia, nausea, and vomiting.
• Assess for the symptoms of upper respiratory infection.
• Assess the child for anxious, irritable, abdominal fullness.

Therapeutic Management:

• Renal biopsy shows normal, so the first line of treatment is corticosteroids. Iv methylprednisolone or oral prednisone should be administered.
• For relieving of edema, Loop diuretics (furosemide) should be administered. Intake and output chart should be strictly followed.
• Metolazone is helpful in preventing of further edema.
• ACE inhibitors are beneficial for reducing the proteinuria.
• Cyclosporin A and tacrolimus are an effective steroid-sparing agent.
• Hyperlipidemia should be treated with Simvastatin, Lovastatin, gemfibrozil, probucol. the child should assess the adverse effect of drugs such as muscle soreness and pain.