Paediatrics: Child with puffiness - Details

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21 questions

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1. Renal problem: nephrotic syndrome, nephritic syndrome 2. cardiac problem: heart failure 3. liver problem: hypoalbuminemia 4. Allergic reaction - angioedema

3 years old with 1 week history of swollen face and hands. Patients have normal development. The parent was well. 3 causes of facial puffiness?

1. nephrotic - proteinuria (frothy urine), oedema, hypoalbuminemia, cx: ascites 2. nephritic - hypertension, oliguria (urine output), haematuria (blood during micturition), sore throat 3. heart failure: sob? reduced effort tolerance, failure to thrive 4. allergy: snake bites, food allergy

3 years old with 1 week history of swollen face and hands. Patients have normal development. The parent was well. 5 question you would like ask patient.

Nephrotic syndrome

Patient had history of passing frothy urine. Investigation result given. i. LFT: hypoalbuminemia ii. Urine: proteinuria, no hematuria Most likely diagnosis

1. Monitor I/O chart 2. Nephrotic chart - BP, albumin, urine dipstick, daily weight 3. Oral prednisolone 60mg/m2/day for 4 weeks --> every alternate day 40mg/m2/day 4 weeks --> reduce 25% by 4 weeks --> stop 4. Diuretics IV Frusemide - gross oedema 5. C Penicillin /Penicillin V as prophylaxis for spontaneous bacterial peritonitis 6. Human albumin

Management of nephrotic syndrome.

Spontaneous peritonitis secondary to nephrotic syndrome

Patient has had one relapse and currently come with complaint of abdominal pain and high grade fever. State provisional diagnosis.

1. FBC 2. Aspirate peritoneal fluid 3. Check urine for proteinuria

Patient has had one relapse and currently come with complaint of abdominal pain and high grade fever. How do you confirm your diagnosis.

Patient - absence from school, unable to perform at school, affect learning curve Family -mother has to take care of him and not the other children (neglect) -mother has to bring him everytime replapse -treatment cost is a burden to family

Patient is now 8 years old. He presented with relapse. He has had 12 relapses in the past 5 years. What are psychological burden of chronic illness on patient and family?

Give cyclophosphamide. Monitor side effect of it : alopecia, neutropenia, haemorrhagic cystitis, gonadal toxicity

Patient is now 8 years old. He presented with relapse. He has had 12 relapses in the past 5 years. How do you manage

Neprotic syndrome: oedema, hypoalbuminemia, proteinuria Nephritic syndrome: hypertension, oligouria, haematuria in nephrotic syndrome, cx is hypoalbuminemia. in nephritic syndrome, cx is hyperalbuminemia.

Triad of nephrotic syndrome? Triad of nephritic syndrome? (hyperalbuminemia/hypoalbuminemia) in nephrotic syndrome, cx is _________. in nephrotic syndrome, cx is _________.

Renal failure, spontaneous peritonitis, hypovolemic shock.

Cx of nephrotic syndrome

1. oedema - common 2. proteinuria >40mg/m2/hour or >1g/m2/day or early morning urine PCI of >200 mg/mmol 3. hypoalbuminemia (<25g/l) 4. hypercholesterolaemia

Diagnosis of nephrotic syndrome (criteria)

1. FBC 2. Urinalysis/ urine dipstick test 3. RP - urea, creatinine, electrolyte 4. LFT - albumin 5. serum cholesterol 6. ASOT 7. Serum compliment (C3,C4) 8. Urine PCI (Quantitative urinary protein excretion)

Investigations in nephrotic syndrome.

1. Primary: common: minimal changes 2. Secondary: post streptococcal glomerulonephritis /SLE

Aetiology of Nephrotic Syndrome.

Steroid resistant nephrotic syndrome (failure to achieve remission despite 4 weeks of adequate corticosteroid therapy)

When is renal biopsy is done?

T. Prednisolone 60mg/m2/day until remission, 40mg/m2/day every alternate day 4 weeks, taper down 25% 4 weeks, and stop.

What is the prednisolone regime for relapsed nephrotic syndrome?