THE STATE UNIVERSITY OF MEDICINE AND

PHARMACY
‘NICOLAE TESTEMITANU’

DEPARTMENT OF PEDIATRICS
Medical report

Name: Asla Salih

Group : M1859
Patient data

1. Name = Manic
2. First name = Gabriel
3. Date of birth =
4. Sex = masculin
5. Age =8
6. Address = Chisinau . Republic of moldova
7. Date of admission =
8. Vaccine status = normal

Basic diagnosis :Glomerulonefrita forma nefrotica .

Complaints on admission
Periodic dureri abdominale,fatigabilitate,edeme
generalizate mai pronuntate pe fata si membrele
inferioare,mictiuni rare,scaderea diurezei,dureri in
faringe,cefalee,voma 1 data pe noapte.
History of present disease
Bolnavul de e data 15.03.2021 in timpul noptii s-a simtit
rau ,a vomitat si a pierdut constiinta,apoi a aparut
edemul palpebral iar dimineata copilul prezinta edeme
generalizatepe fata,member,abdomen si spate.De pe
17.03.2021 internat in sectia nefrologie examinat s-a
stability diagnosticul de Glomerulonefrita acuta cu sd.
Nefrotic de debut.S-a initiat tratament corticosteroid cu
Prednisolon 2 mg/kg.24 ore 6 saptamini apoi trece la
administrarea alternative de Prednisolon cu doza 1,5
mg/kg/48 ore-6 saptamini apoi cu scaderea dozei cu 2,5
mg/saptamina pina la suspendare.In luna 08.2021 s-a
instalat remesiune clinic-paractilica complete.In
12.2021realizeaza 1 recidiva,cu aparitia edemelor
generalizate,protenurie 3,4
On the ambulatory records –
Hb – 130
Leukocyte – 10,40
Non segmented – 9.00
Indice de culoare-0,90
Monocyte – 06.00

Biochemical test
8-lipoproteidele- 97.00
Triglyceride – 2.10
Albumin 07.80
Total Cholestrol 9.09
Total Protein-36,30

PREVENTIVE DIAGNOSIS –
:Glomerulonefrita forma nefrotica evolutie
recidivanta-recidiva 3. Sd. Cusing
medicamentos.Hipertensiune arterial secundara
reno-parenchimatoasa. Faringita acuta.Amigdalota
cronica in acutizare.

Family history
Mama sufera de pielonefrita cronica cuu episoade de
cronicizare.
Allergic status
Nu are alergii.
Vaccination status
Vaccinat conform calendarului.
Physical development

• Copil de la S 1 N1 la 39 s.a nascut prin operatie

cezariana.M=3300g, talia=50 cm.La virsta de 4 luni a
fost operat de hemangioma.Maladii suportate-IRVA
rar.

Physical examination

• General condition – gravitate medie,

• Reactia la mediul inconjurator-obisnuita,
• Constiinta clara,
• Vorbire clara,
• Dispozitie-trista,
• Temperatura corpului 36,6 C,
• Memorie-pastrata,
• Normal distribution of adipose tissue
Musculoskeletal system:
Forta musculara pastrata.Statica si miscarea:miscarile
in articulatie-volum deplin.
 Respiratory sign

• Frecventa respitariei=25 resp/min.

Tusea-absenta,
Respiratie nazala libera,eliminari nazale
absente.Istmul faringian hiperemiant,amigdalee
hiperemiate,marite in volum gr.2.
Plaminii-percutor sunet clar oulmonar,
Ascultativ-murmus verizal uniform bilateral,raluri nu
se percep.

• Respiration frequency = 25 resp/ min.

Cardiovascular system

• FCC-98 b/min,
T/A -110/65 mmHg.
Limitele cordului nu se deplasate.
Zgomotele cardiace ritmice,sonore,
Sufluri absente.
Digestive system examination:
• Limba umeda,curate,
• Abdomenul-palpator permisibil,usor sensibil
periobelical,
• Ficatul la rebordul costal drept,

• *splina nu se palpeaza,

Renal system
• Mictiuni-indolore,
• Semnul tapotamentului lombar pozitiv bilateral,
• Mictiuni-rare.
Sistemul limfatic:
ganglionii limfatici
mobile,indolori,elastici,neaderenti la tesuturile
adiacente.
Nervous system
• Constiinta clara,
• Indispozitie,tristate,
• Memorie pastrata,
• Cefalee periodica,
• Dezvoltarea fizica conform virstei,
• Vorbire-clara.
• Sensitive organs Eyes - pink conjunctiva.
The hearing - preserved.
Nose - common smell.
Differential diagnosis
Glomerulonefrita focală şi segmentară:  GNA
poststreptococice;  GSFS primitivă;  GSFS secundară:
 Infecţie cu virus HIV, reflux vezico-ureteral în nefropatia
de reflux, vasculite, glomerulonefrite proliferative focale,
nefroangioscleroză, diabet zaharat etc.
 Nefropatii glomerulare primitive. Manifestările clinice
în GNA poststreptococică se prezentă după o infecţie
respiratorie care la un interval scurt de timp e succedată
de hematurie microscopică sau chiar macroscopică.
Edemele şi HTA sunt absente. Examenul bioptic renal
evidenţiază la nivelul glomerulilor leziuni morfopatologice
segmentare şi focale. Biopsia renală permite diferenţierea
acestora şi precizarea diagnosticului.
Glomerulonefrita membrano-proliferativă:
 forme secundare a GNMP.
Glomerulonefrita membranoasă: Nefropatia
membranoasă (NM) trebuie diferențiată cu alte
sindroame nefrotice, care pot prezenta proteinurie
masivă. Unele sindroame nefritice pot avea etiologie
similară indentic cu NM. Principalele boli glomerulare
care necesită diferențiere pentru NM:
 Glomeruloscleroza focală segmentară;
 Boala cu schimbării minime;
 Nefropatia diabetică;
 Nefropatia cu depunere de IgA;
 Glomerulonefrita membrano-proliferativă.
Plan of investigation

Analiza generala a urinei:

Cantitatea: 50,00
Culoarea: Gablena,
Densitatea: 1023,00
Reactia: Slab acida,
Transparenta: Tulbure,
Proteine: 25,00
Epiteliu plat: 2-4,
Epiteliu renal: 1-2,
Leucotite: 14-16,
Eritrocite nemodificate: 8-10,
Cilindri hialini: 6-8,
Cilindri granulose: 10-12,
Mucozitati: +++
Oxalatii: +
Bacterii: +

Ultrasonografia abdominala.
Ficatul lobul drept 113 mm, lobul sting 50 mm,
contur regulat. Parenchimul omogen,ecogenitate
medie.
Vena porta 8 mm, V.cava inferioara 9 mm.
Vezica biliara:dimensiuni 59*24 mm,peretii nu0s
ingrosati omogen.
Pancreasul cu dimensiuni 13*10*12 mm.Contur
regulat,structura omogena,ecogenitate sporita.
Splina 74*32 mm,omigena.
TREATMENT PLAN

Recommendation for patients

General measures — While the therapeutic approach is

highly variable on an individual level, there are some
general principles that apply to all patients.

●Photoprotection – Exposure to ultraviolet (UV) light may

exacerbate or induce systemic manifestations of systemic
lupus erythematosus (SLE) . Thus, patients should avoid
exposure to direct or reflected sunlight, and other sources
of UV light (eg, fluorescent and halogen lights).
Sunscreens that block both UV-A and UV-B and have a
sun protection factor (SPF) ≥55 are suggested.
Medications that can cause photosensitivity should also
be avoided in patients with SLE.

●Diet and nutrition – Limited data exist concerning the

effect of dietary modification in SLE. However, a
conservative approach is to recommend a balanced diet
consisting of carbohydrates, proteins, and fats. Additional
considerations regarding diet and nutrition in patients
with SLE include the following:

•Vitamins are rarely needed when patients eat a balanced

diet. However, a daily multivitamin should be taken by
patients who are not able to obtain an adequate diet.

•The majority of patients with SLE have low serum levels

of 25-hydroxyvitamin D (calcidiol), probably due, at least
in part, to avoidance of sun exposure and/or use of
sunscreen products. Vitamin D levels should be
monitored periodically and patients with low vitamin D
levels should be treated with supplemental vitamin D.

•In patients with hypertension and/or nephritis, dietary

measures such as salt restriction may be required.

●Exercise – Inactivity produced by acute illness causes a

rapid loss of muscle mass, bone demineralization, and
loss of stamina resulting in a sense of fatigue. This can
usually be managed with isometric and graded exercise.

●Smoking cessation – Patients should be counseled

against cigarette smoking, since it has been associated
with more active disease . Smoking adds to the baseline
increased risk of accelerated atherosclerosis with
coronary heart disease in those with SLE [64,65]. There is
also evidence to suggest that smoking diminishes the
efficacy of hydroxychloroquine.

●Immunizations – We advise that patients should receive

appropriate immunizations prior to the institution of
immunosuppressive therapies. Recommendations for
vaccination of patients with systemic rheumatic diseases
receiving immunosuppressive medications are
summarized in the following table. Appropriate
immunizations should also include coronavirus disease
2019 (COVID-19) vaccination. Additional considerations
regarding the vaccine and timing of the administration for
patients on selected immunosuppressive therapies is
discussed in detail separately.