1. WELCOME Med Pro Clinic’s Fall Seminar Day 5

2. Case Report #23 Patient –32 year-old male –“Bloated feeling” –Swelling of the face, feet, and ankles –Discomfort around the abdominal area –Malaise

3. Patient –Swelling moved from his face (in the morning) to his feet (at bedtime) –Weight gain Loss of appetite –Urinating less frequently –Denied: Hematuria Blurred vision Allergies Joint pain Cough Hemoptysis

4. Patient –No history of diabetes –No history of previous oliguria –No family history of diabetes –No family history of kidney disease –Malaria Africa and India

5. Physical Examination Edema –Eyes –Face –Extremities –Abdomen –Scrotum

6. Laboratory Findings Temperature taken: 99.1 °F Weight: 214 lbs Heart rate: 75 BPM Blood pressure recorded as: 145/92

7. Laboratory Findings Urinalysis –foamy appearance –marked proteinuria – 10.3 mg/dl –SSA – 3+ –HDL 3 lost into urine –specific gravity – 1.047 Microscopic: »fatty casts – rare »Hyaline casts – rare

8. Laboratory Findings 24-hour Urinalysis –Total protein – 4.5 g –Albumin – 3.2 g

9. Laboratory Findings Blood Tests –Albumin – 2.5 g/dl –Cholesterol – 400 mg/dl Due to hepatic overproduction of VLDL –Triglycerides – 220 mg/dl –Total protein – 5.8 g/dl –A/G ratio – 0.76

10. Differential Diagnosis Anti-nuclear antibody test (serum) »Negative Glomerular basement membrane antibody test (serum) »Negative Ruled out –Systemic Lupus Erythematosus –Lupus Erythematosus –Good Pasture’s Syndrome

11. Diagnosis

12. Prognosis Remission Spontaneous remission

13. Treatment Prescribed –ACEI angiotensin-converting enzyme inhibitor (to reduce protein loss in the urine) –Instructions reduce dietary sodium intake

14. Follow Up 10 days later No edema Weighing 203 lbs Normal frequency of urination Return of appetite

15. Current Research Molecular/genetic causes of Idiopathic Nephrotic Syndrome –Children unresponsive to steroid therapy –Most likely develop end-stage renal disease –Current theory T cells produce permeability factor that affects glomerulus filtration Disruption of normal podocyte (glomerular epithelial cell) function leads to »Proteinuria

17. Current Research (continued) Relationship –Elevated IgE serum levels and Nephrotic Syndrome Conclusion –Higher IgE levels seem associated with poor result

18. Quick Quiz 1.The physical presentation of Nephrotic Syndrome included which of the following: A.edema B.jaundice C.frizzy hair D.skin lesions

19. Quick Quiz 2.The urinalysis dipstick test revealed obvious increase in: A.sperm B.glucose C.Urobilinogen D.protein

20. Quick Quiz 3.Oliguria means: A.Frequent urination B.Scanty urination C.No urination D.Blood in urine

21. Quick Quiz 4.The group of laboratory findings/symptoms that are characteristic of Nephrotic Syndrome are: A.bacteremia, elevated blood glucose, >30 WBCs/hpf microscopic, anorexia B.ketones in urine, renal epithelial cells present in microscopic C.urobilinogen postive dipstick, 3.2 pH level, increased serum albumin levels, hair loss D.proteinuria, edema in the face and extremities, decreased serum albumin, and increased cholesterol

22. Quick Quiz 5.Nephrotic Syndrome can be defined as (select all correct answers): A.Disease or group of diseases that affect the permeability of the glomerulus B.Disease that causes inflammation of the kidneys C.Disease with signs/symptoms including proteinuria, hypoalbuminemia, edema, and hyperlipidemia

23. Thank You for Attending