Student’s name and surname HARSH NIMAVAT

Group IM-457
Date 06.04.2022

Protocol
(Fill the protocol’s parts with the information from the task and write Discharge Summary)
Patient’s Passport data

Name- PETRO STOYAN

Age-09
Sex-Male
Date of admission-06.04.22
Complaints

 Constant headache
 Cola-colour urine (hematouria)

Anamnesis morbi

 The firsy sign or symptom appears 3 days ago.

 Headache
 Cola-coloured urine(hematouria).

Anamnesis vitae

 He and his rest family have cold

 Pregnancy and birth was uncomplicated
 Vaccination is up-to-date
 Weight of child during pregnancy is 3200g and height was 50 cm.
 Child had prolonged neonatal jaundice.
 Doesn’t Have any allergy or genetic disorder
 Breastfeeding from up to 7 months
 From 5 years is on a clinical account due to chronic Tonsillitis, frequent viral respiratory
infections.
 She is on no medication
 Other family has no renal problems
 Child grandmother has hypertension.

Results of objective examination

At the admission - state of moderate severe. Weight - 28 kg, height 135 cm. Skin and visible
mucous membranes pink, clean, facial swelling. Body temperature - 37.4°C. Tonsils are enlarged
(II -III degree), loosened, no covering. In the lungs - vesicular breathing. Heart sounds are clear,
borders location appropriate age. RR – 24/min, HR is rhythmic, 72 beats / min. Blood pressure
130/85 mm Hg. Abdomen - normal form, soft, without tenderness. Liver is at the level of the costal
margin. The kidneys are not palpable, costovertebral angle tenderness was not detected in the both
sides. Daily urine output of 300-400 ml, urine is red.
Physical development Evaluation
Parameter Patient’s Data Which percentile Your conclusion

Around 50
Weight 28 kg It’s normal
Around 50
Height 135 cm It’s normal
25th percentile
BMI 15.4 kg/m2 Normal weight.
Total Conclusion.
BMI is 15.4kg/m2 which is the 25th percentile that indicate child is normal weight.

What syndrome(s) is (are) present in your patient?

 Nephritic syndrome
 Intoxicatiom syndrome
 Edema syndrome

Preliminary diagnosis: acute glomerulonephritis.

Main disease-ACUTE POST STREPTOCOCCAL GLOMERULONEPHRITIS.

Complications –
o Hypertension
o acute renal dysfunction
o heart failure
o hyperkalemia
o hyperphosphatemia
o hypocalcemia
o uremia
o seizures etc

Write the plan of investigation (laboratory and instrumental methods)

1.Complete blood count

2.General urine analysis
3.Biochemical blood test
5.Ultrasound
6.Kidney biopsy

Interpret the results of the analysis (tests) which are given in the case.

 CBC
Hb - 115g/l (normal) {115-145g/l}
Rbc - 4.10*10^12(normal) {3.9-5.3*10^12}
Wbc - 12*10^9(high) {4.5-11.0*10^9}
Band - 7% (high) {3-5%
Eosinopils - 5% (high) {1-3}
Lymph - 24%(slightly low) {25-33%}
Mon - 6%(n) {3-7%}
Esr - 32mm/hr (very high) {3-13 mm/hr}
  URINALYSIS

Genral blood analysis - 45.0 ml,

color – red
transparency – muddy reaction -alkaline
specific gravity - 1.028 glucose
epithelium - 1-2 in f / v
red blood cells - cover the whole visual field
white blood cells - 2 -3 in f / v protein - 2,2 g/l,
casts - none, mucus – none

 BIOCHEMICAL BLOOD TEST

total protein - 45 g / l (low) {60-80g/l}

glucose - 6.6 mmol / L (high) {4.4-6.1mmol/l}
urea - 17.2mmol / L
creatinine – 130 μmol/L (very high) {20-70umol/l}
potassium - 5.21 mmol / l, (slightly high) {3.5-5 mmol/l}
sodium - 141.1 mmol / l (normal) {136-145mmol/l}
cholesterol - 6.0 mmol/l (normal) {0-35mmol/l}
3-lipoproteins - 2.0 g / l. () {}
Coagulogram: fibrinogen – 4.5 g / l,
prothrombin – 130%.
Anti-streptolysin O titre – 1:1500
Endogenous creatinine clearance at 65 ml / min.

Amylase – 33.7 u / l, (normal) {28-100u/l}

Bilirubin total – 10.0 μmol / l() {}
Direct – 3.2 μmol / l(high) {0-5umol/l}
fibrinogen – 3.8 g / l(slight high) {2.2-32g/l}

 ULTRASOUND
Ultrasound of the kidneys: the kidney increased in size, uneven contours. The left Kidney – 122x50
mm, parenchyma – 17 mm. The right kidney – 125x47 mm, Parenchyma – 16 mm. Unevenness
parenchymal echogenicity. Slit-shaped pelvis.

List of diseases for the Differential Diagnosis

1.berger disease iga nephropathy)

2.membranous proliferative glomerulonephritis
3.acute renal diseases
4.chronic kidney disease

Treatment:

1. Regimen-

eat a healthy diet with less protein, potassium, phosphorus, and salt. get plenty of
exercise (at least 1 hour a day) drink less fluids. take calcium supplements. take
medicines to lower high blood pressure.
 2. Diet-
Dietary measures are as follows:
• Low-salt diet - Two grams of sodium per day
• luid restriction - One liter per day
Restricting physical activity is appropriate in the first few days of the illness but is not necessary once
the patient feels well
eat a healthy diet with less protein, potassium, phosphorus, and salt
(berries,broccoli,carrots,spinanch,honey,rice,pasta salad etc.

3. Medications
Antibiotics, such as erythromycin, will likely be used to destroy any streptococcal bacteria that
remain in the body. Blood pressure medicines and diuretic drugs may be needed to control swelling
and high blood pressure.

Erythromycin-50 mg/kg/day for 10 days

Diuretics-20mg/kg/day(furomeside)
Calcium channel blockers-2.5-5mg/kg
 Discharge Summary
Patient’s Name :- PETRO STOYAN
Age __________9___________________
Date of admission _______06/04/2022______________
Date of Discharge: ______________08.04.2022__________
Discharge diagnosis: ACUTE POST STREPTOCOCCAL GLOMERULONEPHRITIS.
Patient history ________The child is a first baby of the family. Pregnancy and birth was
uncomplicated, baby was born on 40th week with weight of 3200g and height of 50cm. He had
prolonged neonatal jaundice. Vaccinations are up to date. He doesn’t have known allergies and any
genetic disorders. Early development was normal. Breast feeding for up to seven months, vaccinated
by age. From 5 years is on a clinical account due to chronic tonsillitis, frequent viral respiratory
infections. There have been no nosebleeds or abnormal bruising. She is on no medication. There is no
family history of renal problems but her grandmother has hypertension.__

Physical Examination: _state of moderate severe. Weight - 28 kg, height 135 cm. Skin and visible
mucous membranes pink, clean, facial swelling. Body temperature - 37.4°C. Tonsils are enlarged (II -
III degree), loosened, no covering. In the lungs - vesicular breathing. Heart sounds are clear, borders
location appropriate age. RR – 24/min, HR is rhythmic, 72 beats / min. Blood pressure 130/85 mm
Hg. Abdomen - normal form, soft, without tenderness. Liver is at the level of the costal margin. The
kidneys are not palpable, costovertebral angle tenderness was not detected in the both sides. Daily
urine output of 300-400 ml, urine is red.

Summary of Diagnostic testing

1.Complete blood count
2.General urine analysis
3.Biochemical blood test
5.Ultrasound
6.Kidney biopsy

Therapies:
Therapy for patients with acute poststreptococcal glomerulonephritis is symptomatic in nature and
depends on the clinical severity of the illness. The major aims are to control the edema and blood
pressure.

Condition on Discharge:
_________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________ ____

Discharge Instructions:
Activity -____ Restricting physical activity is appropriate in the first few days of the illness but is not
necessary once the patient feels well
1. _ Diet ________ Dietary measures are as follows:
• Low-salt diet - Two grams of sodium per day

• Fluid restriction - One liter per day

Medications ___ During the acute phase of the disease, salt and water should be restricted. If
significant edema or hypertension develops, diuretics should be administered. Loop diuretics
increase urinary output and consequently improve cardiovascular congestion and hypertension.
For hypertension not controlled by diuretics, calcium channel blockers or angiotensinconverting
enzyme inhibitors are generally useful. For malignant hypertension, intravenous nitroprusside or
other parenteral agents are used.
__ Antibiotics, such as erythromycin, will likely be used to destroy any streptococcal bacteria that
remain in the body. Blood pressure medicines and diuretic drugs may be needed to control swelling
and high blood pressure.

Erythromycin-50 mg/kg/day for 10 days

Diuretics-20mg/kg/day(furomeside)
Calcium channel blockers-2.5-5mg/kg