CASE STUDY OF

NEPHROTIC SYNDROME
Direct by : Icka Siti Aisah/110170028
Advicer : dr. Irman, Sp.A/dr. Tatan Sp.A/
dr. Ineu, Sp.A

PATIENT IDENTITY
Name
:N
Age
: 10 year old
Sex
: Male
Address
: Cikulak Kidul
Date of admission
: 09 June 2015
Date of examination
: 09 June 2015

Mothers patient
: Mrs. D
Age
: 36 year old
Address
: Cikulak Kidul
Occupation
: Housewife
Education level
: Elementary School

HISTORY TAKING
Chief Complain : Swelling
Patients come to Polyclinic hospital Waled with her
mother for the complain of swelling of the body.
Swelling at start on both periorbital and then bilateral
lower ekstremities and abdominal bloating. Swelling
since approximately one week ago. Complaints swelling
persist and than more severe. Complain accompanied by
urination less than usual, and more intense color.
Defecation is no complain.

Due his complaints were go to the hospital Waled

polyclinic child and hospitalized.
Previous, patient's mother had been went to the
clinic for treatment of patients with similar
complaints, but there was no improvement.
Also according to the patient's mother had also
went to the doctor with swelling complaints. By
the doctor are advised to check the urine and the
results according to doctors is kidney disease.
according to the patients mother, her child was
given medication for kidney in the form of white
pulvus

After that suddenly the patient does not continue

the treatment for about 2 weeks and then the
patient's complaints returned to appeared taken
to the Waled hospital.

 Past

medical history

There was history the same as complain like as now

There was history of urinary such as tea
There was no history to contact with a tuberculosis
patient or unknow prolong cough infection patient
There was no history of skin infection or another
There was history of prolong cough and unheal

Family

history

There was no history the same as complain like as patient

There was no history the prolong cough infection

PHYSICAL EXAMINATION
General Appearance : Composmentis
Blood Pressure : 130/90 mmHg
Pulse : 98x/minute, regular, equal
Respiration : 21x/minute
Temperature : 36,2o C
Weight : 28 Kg
Height : 127 cm
Nutrition Status

BMI/Age
Height/Age

Body surface

: Median
: Median
: 0.99

Head
Form: Normocephal.
Eyes: periorbital edema. His eyes are non-injected,
conjunctiva are not edematous and his throat is not
red, Conjunctiva are not anemic, sclera not icteric.
Nasal : within normal limits
Ears: within normal limits
Mouth: within normal limits, the tooth are not decay
Neck : within normal limits
Thorax : within normal limits

Lun g : Breath sounds vesicular right = left, not cracles, not

wheezing and not rhonchi.
Heart : S1, S2 reguler rhythm, no murmurs and no gallop

 Abdomen

is soft, non-tender, nondistended and without masses, shifting

dullness (+) No hepatosplenomegaly.
He has normal male genitalia with no
scrotal edema.
The dorsal surfaces of his hands and lower
extremites have pitting edema. He has
brisk capillary refill and 2+ pulses.
No rashes

FURTHER EXAMINATION
1. Urinalysis :
Specific

gravity : 1.030 (1.000-1.030)

Protein : 100 (10 mg/dL)
Serum Albumin of 1.21 (3.5-5.2g/dL)
Cholesterol of 513.80 (119-202)
Eritrocyte : 10 (0-1 /uL )
BUN and creatinine are normal limits

2. Complete Blood Count are normal limits

3. Rontgen Thorax : Thickening of bronchovascular bundles
infiltrates duplex in the bronchial dextra more dominant

PROPOSED EXAMINATION
Serological ASTO
Mantoux Test

DIFFERENTIAL DIAGNOSIS
Nephrotic Syndrome
Acute Nephrotic Syndrome

Working Diagnosis

Nephrotic Syndrome

MANAGEMENT
a. General
- Low-salt diet
- Bed rest
b. Medikamentosa

Prednisone 60 mg/sq-meter/day divided in 3-doses

for 4 weeks

Diuretics: Furosemide 1-3 mg / Weight / day =

56mg/day furosemide

Albumin Infusion 1 gr / Weight = 28 gr Albumin

serum

Captopril 2 x 6.25 mg

Follow

09

11

12

13

14

15

16

17

18

Up

jun

june

june

june

june

june

june

june

june

100

30

201

2015

2015

2015

2015

2015

2015

2015

2015

Kadar
protein
urine

500

Tekanan
darah

130/90 120/90 120/90 110/80 100/60 100/80 100/80 100/80

mmHg mmHg mmHg mmHg mmHg mmHg mmHg mmHg

Kreatinin 0.51

Ureum

100

21.2

THANK YOU