NEPHROTIC SYNDROME WITH TYPE -I DM, HYPERTENSION,RIGHT PLEURAL EFFUSION

A 20 yrs old female who is a house wife was brought to the casualty with the C/O
• B/L pedal edema since 1 months
 •Shortness of breath (grade 2-3 ) since 1 months,which is insidious on onset gradually progressive not associated with orthopnea /PND
•Decreased urine output since 10 days 
•Swelling of lips since 3 days
HOPI:-
Patient was apparently asymptomatic 11years ago,then her parents observed her eating more food, increased urine output on a regular check up she was  diagnosed with diabetes type -1(On insulin since then) 

2018-  Patient became drowsy and brought to the hospital , diagnosed with?DKA 
From then she is on MIXTARD 18UNITS MORNING,12UNITS NIGHT
•1 year ago ,she got married
• 6 months ago- She was brought to the hospital as she has C/O Fever , Not eating food for 5 days.Then she was diagnosed Hypertensive ,since then she is on Telma 40 mg 
•3 Months Ago , patient was diagnosed with UPT positive and had abortion 2 months ago as fetal cardiac activity is absent
• On 9/4/22- Patient was brought to hospital as she has 
C/O B/L pedal edema since 3 months, Pitting type 
 •Shortness of breath (grade 2-3 ) since 3 months,not associated with orthopnea /PND
•Decreased urine output since 10 days 
•Swelling of lips since 3 days
FAMILY HISTORY:
Maternal uncle's have DM-2
GENERAL EXAMINATION:
Pt is conscious, coherent, cooperative
Bp-150/90 mmHg
Pr-91bpm
Temp -98.5°F
SpO2- 91%@RA
GRBS -254mg% @admission

CVS : S1 S2 +, Apex beat : 5th ICS mid clavicular line.

RS : BAE +, Decreased breath sounds in Right infra axillary,midscapular ,infrascapular regions,No crepts 

CNS : NAD

P/A : Soft, no tenderness . Bowel sounds +

Pallor ++,Edema present in both limbs ,face ,abdomen



No icterus, cyanosis, clubbing or lymphadenopathy

PROVISIONAL DIAGNOSIS: 
? NEPHROTIC SYNDROME WITH K/C/O TYPE -I DM(since 11yrs) ,K/C/O HTN (6 months) ,RIGHT PLEURAL EFFUSION




INVESTIGATIONS:
ABG :


RBS - 260mg/dl
SERUM IRON-95 ug/dl
Reticulocyte count -0.7%


BLOOD GROUPING AND TYPE:- O POSITIVE

PERIPHERAL SMEAR:
RBC : Mild Anisocytosis with Microcytic Hypochromic Cells few Normocytes seen
WBC : With in normal limits
PLATELET : Adequate

CHEST xray:
2dECHO :

USG Abdomen and pelvis:




Plan of treatment:
1.Head end elevation upto 30°
2.O2 supplementation if spO2<90%
3.Inj.HAI s/c pre meal 
4.Tab.Telma 40 mg PO/OD
5.Inj.LASIX 40mg /IV /TID(If SBP <110 mmhg )
6.Salt restriction <2.4 gm/day
7.Fluid restriction <1lit /day


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