19 year old female with anasarca

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 This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input. 

24/4/21

19 Year old female came with cheif complaints of generalised swelling with decreased urine output since 10 days 

complaints of multiple joint pains since 2 years 

HOPI :-patient was apparently asymptomatic 2 years ago 

Patient had complaints of fever with bilateral ankle ,knee  joint pain with swelling and difficulty in walking due to pain 

Later within 1 week after the onset of these symptoms patient had bilateral interphalyngeal joint pains , elbow , shoulder wiyth restriction of movement  , swellings 

Patient with these complaints visited a local doctor and was told to have rheumatoid arthritis started on Tab.Wysolone 20mg OD , tab.hydroxychloroquine 200mg OD

Patient symptoms improved after using medicstion 

Came with complaints generalised swelling of the body (facial puffiness f/b pedal edema and abdominal distension)

And decresed urine output since 10 days

No c/o any skin rash,alopecia,oral ulcers,bleeding manifestations,photo sensitivity, fatigue,chest pain,SOB

No difficulty in memorising things,no H/o seizures,limb weakness,tingling and nimbness of limbs.



PAST HISTORY :-Not a k/c/o of DM,HTN ,CAD,EPILELPSY,CVA,TB 

PEERSONAL HISTORY :- mixed diet and normal apetite no addictions 

FAMILY HISTORY:-no significant family history 

Pulse rate :- 86bpm

Respiratory rate :- 14 cpm

BP:- 90/60 mmhg.    

Spo2:-98 %

Pedal edema+pitting type

CVS:-S1 S2 present no murmurs 

CNS :- no focal deficits 

P/A :- soft non tender 

RS:- BAE







ANA +, Low C3,C4 levels,Anti ds DNA antibody+(29IU/L)

Plan for renal biospy

Done on 

29/4/2021



Biopsy report awaited -Patient was discharged with following advice



Renal biopsy report




Gross appearance :- single grey white linear tissue bits all together measuring 1.2 cms embedded in one block .3 linear cores for immunoflourescence embedded in  two blocks.

Microscopic examination:multiple sections show total of 22 glomeruli of which 8 shows increase in endocapillary cellularity , increase in mesangial matrix and cellularity.Segmental glomerular basement membrane thickening noted.No cresent formation,no hyaline thrombi,tubules are nil remarkable.

Interstitium no inflammatory infiltrate and no fibrosis

Blood vessels:No significant pathology

Immunofluoroscence findings: full house pattern mesangial and focal GBM ++ to +++ positivity noted

IMPRESSION: Light microscopy and immunofluoroscence findings suggestive of LUPUS NEPHRITIS CLASS II/III


LUPUS NEPHRITIS CLASS II/III

 


Treatment adviced:

TAB.TELMA 20mg PO BD

TAB.LASIX 20mg PO BD

TAB.SHELCAL 500mg PO OD

TAB.WYSOLONE 10mg BD

TAB. MYCOPHENOLATE MOFETIL 500mg BD


FOLLOW UP

Patients edema reduced over the next 6months,Tab wysolone tapered to 5mg OD



Follow up on 18/4/2022:Currently no c/o pedal edema,facial edema or abdominal distension,urine output adequate.No c/o joint pains or swellings.Currently pt is on Tab.Wysolone 2.5mg OD,Tab mycophenolate mofetil 500mg BD.Urea-22,creat-1.2,Spot urine protein creatinine ratio-1.09.




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