Case study:

Patient’s information:

 Name of patient: Hadia

 Gender: Female
 Age: 1 year
 Weight: 10.6 kg
 Ward: Nephrology

Presenting complain:

 Urinary retention

Physical examination:

 General look: unstable

 Abdomen: firm, tender
 Fever: no
 Urine output: adequate

Vital signs:

 HR: 152
 RR:32
 Temperature: 37c
 O2sat:91
 Bp: raised

Urine examination:

examination result Normal range

Color Pale yellow
Ph 5 4.8-7.4
Creatinine 64 mg/dl 0.6-1.2 mg/dl
Urea 30 mg/dl 4-15 mg/dl
Leukocyte esterases 25 Leu/µ <10 Leu/µ
Protein 500 mg/dl <10 mg/dl
leukocytes 6 cells/h.p.f <4 cells/h.p.f

Investigation:

 CBC, UCE, pseudomonas species

Working diagnosis:

 Nephrotic syndrome 1st episode

Symptoms of current disease:

 Urinary retention
 Swelling over eyes
 Cola colored urine whwn child was cathetized

Treatment of current disease:

 Tab. Deltacortril (prednisolone) 5mg*4 OD

 Syp. Peptiban (famotidine) 5ml BD
 Syp. Zinnat (cefuroxime) 5ml OD
 Tab. Lasoride (amiloride) 4omg ½ BD
 Low osmolar ORS 100-200ml SOP
 INJ. 0.45% DS 500ml IV in 24 hrs
 Hydrozole cream twice daily
 Maintain i/v line

Monitoring:

 I/O Charting
 Bp monitioring

Discussion:

 In this case,the child is suffering from nephrotic syndrome having adequate urine output plus
large amount of protein in it, leads to extra water in body causing edema (swelling over the face
and legs) and high blood pressure.
 Deltacortril (prednisolone) is given because it is a steroidal drug that will get rid of the protein
in urine and extra water, but it has some side effects such as it can cause stomach ulcer or may
develops rash.
 To avoid stomach ulcer peptiban (famotidine) is given to child. famotidine is a histamine-2
blocker that blocks the amount of acid production in stomach.
 To treat rashes hydrocortisone cream is given.
 The urine sample contains pseudomonas species that cause infection that’s why the leukocytes
counts are more than the normal. For the treatment of bacterial infection zinnat (cefuroxime) is
given. cefuroxime is cephalosporin antibiotic.
 As the child has high blood pressure thus lasoride (amiloride) is given. Amiloride is a diuretic
(water pill) used to treat CHF and high BP and edema.
 In nephrotic syndrome low protein levels in blood may lead to a reduction in blood volume that
leads to dehydration. To treat dehydration low osmolar ORS is given. Also dextrose saline is
given which is used to maintaine and balance fluid and electrolyte in body.