Mornlng 8eporL

!lm CoLLlleb C?2

10/26/2011
C# PlLory
W 9 2 year old male wlLh hlLory of premaLurlLy (32 week geLaLlon) cerebral paly developmenLal delay fallure
Lo Lhrlve and elzure dlorder preenLed from CSP wlLh fever rah dehydraLlon and 2 week hlLory of perlorblLal
edema arenL reporL LhaL he had been feellng well when Lhey flrL noLlced hl perlorblLal edema 2 week ago aL
LhaL Llme he had no oLher ympLom and urlne ouLpuL wa approprlaLe 1hen abouL 3 day ago he LarLed Lo have
fever (up Lo 103) lgnlflcanLly decreaed energy lnLermlLLenL nonprurlLlc blanchlng rah on hl face
abdomen and back and poor appeLlLe urlne ouLpuL decreaed over Lhe paL couple of day a oral lnLake
worened arenL LreaLed wlLh moLrln whlch wa effecLlve uurlng Lhe paL couple day whlle hl oral lnLake wa
poor hl edema had reolved 1he edema Lhen reappeared afLer recelvlng lv fluld on lnlLlal preenLaLlon
W Slnce lnlLlal preenLaLlon he recelved Lhree 20mL/kg bolue
W fever rah dehydraLlon poor oral lnLake LomaLlLl decreaed urlne ouLpuL perlorblLal edema All oLher
yLem revlewed and oLherwle negaLlve
W 9,
W 8orn aL 32 week (no known eLlology for premaLurlLy)
W erebral aly
W lallure Lo Lhrlve followed by ur ohl
W Selzure ulorder ha had no elzure lnce LarLlng LrllepLal Lhree week ago
C# PlLory (conL)
W DLVLL9,LN1 rawllng crullng palng ob[ecL beLween hand no word
W ,L ,LD
W henobarblLal and 1rllepLal dally
W ulaLaL a hl elzure recue medlcaLlon
W 8enadryl a needed for leep
W MoLrln a needed for paln or fever
W N91LN1 ,LD
W 1rllepLal
W henobarb
W 1ylenol
W lbuprofen
W LLLL keppra behavlor problem eplLaxl dlcolored urlne
W 9 none
W
W SLrong famlly hlLory of hemochromaLol (moLher MCM oLher relaLlve on maLernal lde)
W aLernal uncle and couln wlLh elzure dlorder
W MCl wlLh renal dleae (unknown eLlology)
W MCM wlLh P1n a an adulL
W Llve ln Spanlh lork wlLh moLher faLher 2 older lbllng
C hylcal Lxam
V|ta| s|gns
W JelghL 126 kg (112kg Lhree week prlor) 1emp 361 8 6/61 P8 104 88 26
W SaLuraLlng 99 on naal annula aL 1 LM
W CLn SlLLlng on dad lap anxlou durlng exam
W PLLn1 n/A1 LCMl L88L con[uncLlvae clear clerae nonlcLerlc lgnlflcanL perlorblLal edema 1M clear MMM
naopharynx clear poLerlor oropharynx l eryLhemaLou wlLh caLLered lelon no Lonlllar hyperLrophy no naal flarlng
naal cannula preenL
W nLk Supple no LAu no mae
W LunCS 1A8 lncreaed 88 wlLh no reLracLlon or ue of acceory mucle good aeraLlon bllaLerally no crackle or
wheeze
W v 888 no murmur of gallop caplllary reflll 2 ec femoral/radlal pule are 2+
W A8u llrm and dlLended and mlldly Lender uch LhaL l cannoL ae for hepaLoplenomegaly or mae normoacLlve bowel
ound no hernla
W Cu normal 1anner Lage l M exLernal genlLalla urlne bag preenL Mlld croLal edema
W Lx1 no clubblng cyanol lLLlng edema preenL ln bllaLeral LL up Lo Lhe Lhlgh
W Skln Ceneral pallor 8lanchlng nonpalpable plnk rah on face cheL and back
W nLu8C no obvlou focal deflclL normal LrengLh and Lone 23 beaL of clonu aL bllaLeral ankle
2 y/o male wlLh complex MP preenL wlLh fever rah
generallzed edema (hepaLoplenomegaly unknown)
ulfferenLlal ulagnol

LaboraLory LvaluaLlon
LaboraLory LvaluaLlon
W L
W 8 J8 76 dlfferenLlal 373 neuLrophll 0 8and form 31 LymphocyLe 0 MonocyLe 0 Lolnophll PemaLocrlL 391 laLeleL 139
W urlne Mod Pgb 3+ 9t LL neg nlLrlLe neg J8 3 88 12 8acL nLC
W ompleLe MeLabollc anel [ 0336 na 12 repeaL aL 000 129 k 42 l 104 C2 24 8un 69 r 067 Clucoe 92 a 62 roLeln
33 |bum|n 12 8lllrubln 01 Alk ho 163 AL1 20 AS1 77
W Sl 2J8 (2Mn 73 L 61M) 388 roL 10 Cluc 36 LnLerovlru 8 neg
W Mlcro 8lood Sl urlne Croup A Lrep ulA pendlng
W v8 neg
W 9t]C at| 283 (002 nl)
W L|p|d Ch| 244 1 8S0 DL 30 n| Ch|]DL 81
W 3 0 nl 4 33 nl
W ,LDCL ,N
W 7/21 x8 Lung volume are omewhaL low 1here are lncreaed perlhllar and perlbronchlal marklng 1here l a very mall pleural effulon probably
on Lhe lefL vllble alrway are paLenL 8one are lnLacL
W 7/21 ku8 lmprelon Small lefL pleural effulon no acuLe lnLraabdomlnal proce
nephroLlc Syndrome
W ueflnlLlon
1 Ldema
2 Pypoalbumlnemla (23g/dL)
3 roLelnurla* (ur/r 30)
4 PypercholeLerolemla
W Lpldemlology
lncldence 27 new cae/100000 per year
revalence 16/100000 chlldren
Mean age of oneL 33 year
Male predomlnance (21)
C|ass|f|cat|n
rlmary (ldlopaLhlc) 90
3 Mlnlmal hange
1013 lSCS
4 Membranou nephropaLhy
Secondary 10
lnfecLlon drug mallgnancy SLL
MCn lgA nephropaLhy uM
1reaLmenL
1 uleL Low odlum dleL fluld reLrlcLlon
2 MalnLaln lnLravacular volume May conlder
albumln
1 SLerold rednlone
60mg/m2 8SA per day x 6 wk followed by 40mg/m2 every oLher
day x 6 week
90 Mlnlmal hange repond 60 of Lhee paLlenL relape
lrequenL relaper May beneflL from cyclophophamlde or
cyclopolnre mycophenolaLemofeLll
ompllcaLlon
W 1hrombol uually venou aglLLal lnu pulmonary
vaculaLure renal veln perlpheral can be arLerlal
urlnary lo of proLeln LhaL lnhlblL coagulaLlon (A1 lll) and proLeln S
deLablllzaLlon of plaLeleL by hyperllpldemla lncreaed flbrlnogen
lncreaed blood vlcolLy
W lnfecLlon Pypogammaglobullnemla (lgC) econdary Lo lncreaed
urlnary loe and decreaed ynLhel lmpalred 1 cell funcLlon
complemenL yLem l alLered Lherefore decreae our ablllLy Lo flghL
encapulaLed organlm
erlLonlLl SLrep neumo (Cm neg 3)