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An Young Adult Female with Focal Segmental Glomerulosclerosis

A 21-year-old female from narketpally came with complaints of loose stools since 2 weeks, 3-4 episodes per day, associated with mucous, non-foul smelling, non-blood stained, associated with pain in the left iliac fossa, intermittent, radiating to left loin. Vomitings for 2 weeks, after food intake, nonbilious, nonprojectile, non-blood stained, history of nausea present. Symptoms didn't relieve after taking medication (levofloxacin, metronidazole) prescribed outside. H/o pedal edema and facial puffiness on and off for 4 yrs. 

Past history - diagnosed focal segmental glomerulosclerosis (FSGS) 4 years back (biopsy is done), used steroids for 1 year, on tab cilnidipine 10mg+telmisartan 40 mg for hypertension, not a known case of diabetes, thyroid disorder, tuberculosis, bronchial asthma.

Family history- no history of similar complaints in the family

Personal history- The patient takes a mixed diet, appetite decreased for 2 weeks, bladder habits normal, loose stools for 2 weeks, sleep adequate, non-smoker, non-alcoholic.

General physical examination-
Patient lying supine on the bed, temperature-afebrile, pulse rate 92 bpm, regular (right radial artery),
Respiratory rate of 18 CPM, blood pressure of 140/90mmHg (right arm supine). 

Pallor +, no icterus, cyanosis, clubbing, cyanosis, , koilonychia, lymphadenopathy, facial puffiness
present

Inspection - the shape of the abdomen scaphoid, all quadrants moving equally with respiration, no visible scars, sinuses, mass. 

Palpation- mild tenderness over left iliac fossa, no local rise of temp, no palpable mass.

Auscultation: 
GI System: Bowel sounds heard. 
CVS- s1s2 heard, no murmurs
Respiratory system- bilateral air entry present, normal vesicular breath sounds were heard
CNS- no focal neurological deficit

Investigations-
Complete blood count: -HB% 6.4%, TLC 6,900, Plateelt 1,71000/mm3

Urine R/E: Albumin 3+, sugar 1+, pus cells 6-8

Renal function test- serum urea 74 md/dl, serum creatinine 7.3 mg/dl , serum uric acid 6.7 mg/dl, serum Na -140, k+ 4.0, CL- -108 mEq/L

Ultrasound of the abdomen- pelvic ascites, renal parenchymal disease.

Provisional diagnosis- Acute gastroenteritis. 

Known case of nephrotic syndrome secondary to FSGS with hypertension









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