Case Study of Acute Nephrotic

Syndrome

DIRECT BY : SITI NURJANNAH

ADVICER : DR. IRMAN, SP.A

 Patient Identity
 Name :J
 Age : 9 years old
 Sex : Male
 Address : Pabedilan Kulon
 Date of admission : 26 June 2015
 Date of examination : 30 june 2015

 Mother’s patient : Mrs. M

 Age : 30 years old
 Address : Pabedilan Kulon
 Occupation : Housewife
 Education level : childhood School
 History Taking

 Main Complain : Edema

 patients coming in Emergency departemen with
complaints of fever, breathless, Decreased appetite,
headache,her mother for the complain of oedema in
a body. Edema at start on both periorbital, cheeks
and feet, and then bilateral ekstremities. Edema
since approximately five days ago. Complaints
edema persist and than more severe. Complain
accompanied by urination less than usual, and
urination colour still brown cloudy.
 Past medical history
 There are history the same as complain like as
now
 There are history of urinary such as tea, like a
coca-cola
 There are of the right kidney tumor and has
been in operation 3 years old

 Family history
 There was no history the same as complain like as
patient
• Treatment history
patients had medical treatment and health centers

• Immunization history
Hepatitis B : 2x, polio 5 x, BCG 1x, DPT 4x, Campak 2x

• Social history
Patients often consume soft drink
 Physical Examination

 General Appearance : full alert

 Blood Pressure : 140/80 mmHg
 Pulse : 100x/minute, regular, equal
 Respiration : 28x/minute
 Temperature : 36,4o C
 Weight : 26 Kg
 Height :131 cm
 Nutrition Status
• BMI/Age : < pesentil -3
• Height/Age : < pesentil -3
 Head
 Form: Normocephal.

 Eyes: periorbital edema. conjunctiva are not edematous,

Conjunctiva are not anemic, sclera not icteric.
 Nasal : within normal limits, and no secret

 Ears: within normal limits

 Mouth: within normal limits, the tooth are not decay

Neck : within normal limits

Thorax : Symmetryc with good expantion
Intercostal retraction (-)
 Lung : Breath sounds vesicular right = left, not cracles,
not wheezing and rhonchi
 Heart : S1, S2 reguler rhytm, no murmurs and no gallop
Abdomen
Is soft, non-tender, non-distended and without masses,
fluid wave (-) shifting dullness (-). Bowel sound (+)
within normal limits.
Liver : non palpable
Lien : non palpable
Genetalia
He has normal male genitalia with no scrotal edema

Extremites
The dorsal surfaces of his hands and lower extremites
have pitting edema. He has brisk capillary refill time <
2 ‘’.
 Differential diagnostic

 Nephrotic Syndrome
 Acute Nephrotic Syndrome
 Further diagnostic

Complete Blood Count and urinalysis

 Further diagnostic

Urinalysis
Component 30 june 2015 Sedimen
Colour Yellow Epitel 1-2
turbidity Cloudy
Eritrosit 0-1
Protein urine (H) 25
Glucose urine Norm Lekosit 12-15

pH 7 Silinder Neg
Bilirubin urine Neg Kristal Neg
Urobilinogen Norm
Density urine 1,005
Keton urine Neg
Lekosit 100
Eritrosit 250
Nitrit Neg
 Working Diagnostic

Acute Nephrotic Syndrome

 Management

Medikamentosa
 Infusion D5
 Captopril 2 x 6,25 mg
 Furosemide 3 x 10 mg
 Nifedipin 5 mg
THANK YOU