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

Comments

55 years Old male with Bipolar affected disorder moving from depression to Manic to depression phase

Disclaimer:- This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here December 2017 after collecting informed patient consent (form downloadable Click Here) This is a case of a 55 years old, diabetic, hypertensive patient who was diagnosed with Bipolar affected disorder since 1995. In 1995 due to financial loss he was attacked by this condition. He was seen by Dr. D. K Agarwala and diagnosed as BPAD-Depression phase and treated with lithium, sodium valporate, propranolol, Zeptol cr, Nitrosum - S. With the treatment he was reasonably well but every 6 months of interval he appeared to have some disturbance like didn't want to talk to anybody, forgot to smile etc. They went to the doctor and treated accordingly and was continuing the treatment. In the year of 2013, August he was diagnosed with BPAD-severe depression phase but, he was not responding well to the medications and then they went to NIMHANS for

Consent Forms

Hindi BMJ Consent form Bengali BMJ Consent form English BMJ Consent form Telegu BMJ Consent Form Telegu BMJ Consent Form UDHC Consent Form

drugs to avoid or use in terms of their pregnancy category

The optimal AEDs therapy of women with epilepsy who are of childbearing age is unclear because of a lack of conclusive data on the comparative teratogenicity of different antiseizure drugs and no antiepileptic drug has proven safe in pregnancy in terms of teratogenesis. Data on the comparative efficacy of various antiseizure drugs for controlling seizures during pregnancy are also quite limited, and there are no randomized trials in this setting. Treatment must be individualized for all patients. Women with epilepsy are classified as high risk during pregnancy and as there are no clear data indicating that any drug is without risk in pregnancy therefore, the antiseizure drug regimen should be optimized six months prior to planned conception. Choice of antiepileptic drugs in women of childbearing age and pregnant women with epilepsy: 1. T he antiseizure drug that stops seizures in a given patient is the one that should be used with an exception of valproate. 2.

BMJ Elective Case Log

Search This Blog