Nephrotic Syndrome

Patient particulars
Name
Age
Gender
OcCupation
Religion
Address
Informant
Name of informant
Date of admission
Date of Examination

Chief complaints
1.Puffiness of eyes and face for 1 month
2.decreased urine output for 1 week

History of present illness

The patient was apparently well before 1 months then she developed
Swelling around her eyes and face for last one month which was
insidious in onset and gradually progressive

The mother noticed swelling of bilateral lower limbs after two days ,the
swelling is more in the morning
Mother has noticed reduction in both frequency and amount of urine
passed Since one week

No history of breathlessness on exertion ,chest pain ,recurrent

respiratory tract infection
ww.history of altered appetite ,jaundice ,blood in stool
No history of cola coloured urine, headache ,blurring of vision
No history of recurrent infection, Weight loss, skin lesion rashes

Past history
No history of Tuberculosis,Measles

Treatment history
The child was not on any regular medication

Antenatal natal and postnatal history

Antenatal history: The child is of 2nd child with a gap of one year
between the first and second child.

The mother is a registered case and history is as follows:

First trimester
no history of fever, rash
folic acid was taken
no other drug intake radiation exposure
or

no alcohol/ tobacco abuse

Second trimester:
Quickening felt at 18 weeks
2 doses of tetanus toxoid taken one month apart
iron folic acid and calcium taken
No history of headache , swelling of feet ,blurring of vision ,pedal
oedema ,documented hypertension
No history of polyuria polydipsia
Third trimester:
appreciated fetal movement well
No history of maternal fever ,diarrhoea UTI
No bleeding per vagina
Birth history.
Place:
Mode: normal vaginal delivery
Period d of gestation:39 weeks ofgestation
baby cried immediately after birth

Neonatal history
Birth Weight:2.9 KG
full term
cried immediately after birth
breastfeeding started 30 minutes after delivery
breastfeeding was done adequately on demand at day and night
No respiratory difficulty jaundice, cyanosis

Developmental history
The child is developmentally normal and all milestone are regularly
achieved
Gross motor development
fine motor development
speech or language development
immunisation history
Vaccine taken up to date as per national information program

following immunisation-no
any adverse reaction
BCG scar present

Dietary history
The child was exclusively breastfeed till 6 months of age
she has been started complimentary feet at 6 months of age.
Breastfeeding stopped by one andhalf years of age.
hour recall method
Time Food items Amount Calorie Protein
1. Morning

2.Afternoon
3.Evening
4. Night
www.wwwe ***

Family history
5 members in her family
youngest siblings age is 3 years
Mother educational history
There are no consanguineous marriage
There is no history of tuberculosis contact, similar complaint, early
death due to congenital disorder.

Socio-economic status

General examination
Child is conscious alert and cooperative
Examined in supine position
Nutrition-
Anthropometric measurement
Weight
Height
Arm span
Pallor

Cyanosis
undice-
Clubbing
Oedema- Generalised oedema present with facial and Perry orbital
fasteners
Neck vein-
Neck gland-

Vitals
Pulse-98 bpm good volume regular no delay all peripheral pulses felt

BP-not measured
Respiratory rate-32 per minute
Temperature-98.6° fahrenheit
Regional examination
Head to toe examination
Head-normal in size and shape
Hair- hypopigmented lustreless,thin
Face-periorbital puffiness ,facial puffiness
Oral cavity- no ulcers, fissure at the angle of the mouth and lips, no

cleft lip and palate,Gam bleeds, dentition normal,no dental caries,

tonsil and throat normal
Eyes-pallor present,
No icterus ,bitots spot ,ulcer ,scar,corneal neovascularisation,
conjunctivitis ,conjunctival hemorrhage
Ears-no discharge
Nose and nasal Cavity- normal
Neck-no rashes around Nick

Vitals
pulses felt
Pulse-98 bpm good volume regular no delay peripheral
all

BP-notmeasured
rate-32 per minute
Respiratory
 mperature- 98.6° fahrenheit
Regional examination
Head to toe examination
Head-normal in size and shape
Hair-hypopigmented lustreless,thin
Face-periorbital puffinessfacial puffiness
Oral cavity- no ulcers, fissure at the angle of the mouth and lips, no
cleft lip and palate Gam bleeds, dentition normal ,no dental caries,
tonsil and throat normal
Eyes-pallor present,
No icterus ,bitots spot ,ulcer ,scar ,corneal neovascularisation,
conjunctivitis ,conjunctival hemorrhage
Ears-no discharge
Nose and nasal Cavity- normal
Neck- no rashes around Nick

Systemic examination
GIT: Examined in supine position
Inspection
Abdomen uniformly distended flanks are ful/free
Corresponding quadrant move equally with respiration
umbilicus-central
No scar mark
superficial dilated vein present
no visible peristalsis or Pulsations
External genitalia: scrotal and penile oedema present

Palpation
No local rise of temperature and tenderness
Pitting oedema present

On the palpation liver ,speen, kidney are non-palpable, no tenderness

 ominal girth 53 cm

Fluid trill absent

percussion
Shifting dullness is present
Auscultation
Normal bowel sound are heard

Respiratory system
is thoraco abdominal type. Normal vesicular breath sounds
Respiration
heard

Cardiovascular system
S1 S2 heard ,no murmur
Pericardial Rub present

Provisional diagnosis
oliguria most probably of rain a little easy with
Generalised oedema with
or without him a chootiya most probably nephrotic syndrome.