History and Physical Examination -Marana, Aervin L. MEDIIB Case: 6yo. Male, Sto.

. Domingo, Ilocos Sur Puffy Eyelids and Bloody Urine 6 days prior to consultation Puffy eyelids 4 days prior to consultation Reddish urine brought to Health Center admitted. PMH: Treated for PTB for 6mo. PE: Patient is conscious, coherent, weak-looking. Vital Signs: BP 130/80 CR 100/min RR 32/min. Temp. 36.5 C Wt. 22kg. (+) Periorbital Edema (+) Bipedal Edema Other PE - Normal Edema of the Face Hx and PE Ask if the facial edema developed suddenly or gradually. Is it more prominent in early morning. Worsen throughout of the day. Weight gain. How much and over what length of time. Change in urine color or output. Appetite Drug Hx. Recent facial trauma Begin PE by characterizing the edema

Localization: one part of the face, entire face or other parts of the body. Determine if its pitting or non pitting, grade and severity. Take Vital signs Assess oral cavity evaluate dental hygiene for signs of infection. Visualize the oropharynx and look for soft tissue swelling. Pediatric Pointers: Normally periorbital tissue pressure is lower in children than in adults. As a result, children are more likely to develop periorbital edema. Periorbital edema is more common than peripheral edema in children with such disorders as heart failure and acute glomerulonephritis. Bipedal Edema - Hx and PE Ask how long he has had the edema. Suddenly or gradually Decrease if he elevates his legs. Painful when touched or when he walks. Is it worse in the morning or does it progressively worse during the day. Ask recent leg injuryor recent surgery. Ask about history of cardiovascular disease. Check for Pitting edema Leg edema may compromise arterial blood flow, palpate or use doppler to auscultate peripheral pulses to detect insufficiency. Observe leg color and look for unusual vein patterns. Palpate for warmth, tenderness, and cords, and gently squeeze the calf muscle to check for deep pain. Hematuria - Hx. And PE Hematuria is macroscopic: Ask when he first noticed blood in his urine.

Does it vary in severity between voidings. Is it worse in the beginning, middle or end of the urination. Occured before?, Passing clots, Pain or burning with hematuria episodes. Ask about recent abdominal or flank trauma. Note a history of renal, urinary or coagulation disorders. Obtain drug history noting anticoagulants or aspirin. Begin, PE by palpating and percussing the abdomen and flanks. Next, percuss the costovertebral angle to elicit tenderness. Check urinary meatus for bleeding or other abnormalities. UA,DRE

-Usually resolves in 1-2weeks. Proteinuria

Poststreptococcal Glomerulonephritis -Characterized by the sudden appearance of edema, hematuria, proteinuria and hypertension. -Affects children between the ages of 2 and 14 years. -It is more common in males. Differential Diagnoses: Subacute Bacterial Endocarditis The clinical presentation of these conditions is variable and includes proteinuria, microscopic hematuria, and acute renal failure. Lupus Nephritis The most common clinical sign of renal disease is proteinuria, but hematuria, hypertension, varying degrees of renal failure, and active urine sediment with red blood cell casts can all be present. Antiglomerular Basement Membrane Disease Disease in the younger age group is usually explosive, with hemoptysis, a sudden fall in hemoglobin, fever, dyspnea, and hematuria. IgA Nephropathy The two most common presentations of IgA nephropathy are recurrent episodes of macroscopic hematuria during or immediately following an upper respiratory infection often accompanied by proteinuria or persistent asymptomatic microscopic hematuria. Nephrotic syndrome, however, is uncommon. Proteinuria can also first appear late in the course of the disease. ANCA Small-Vessel Vasculitis Granulomatosis with Polyangiitis (Wegener's) -Urine described as being smoky, cola colored, tea colored, or rusty. -Color dependent on the amount of blood in the urine and the pH. Hypertension -Third cardinal feature of poststreptococcal acute glomerulonephritis. -Reported in 50-90%of patients. Microscopic Polyangiitis Churg-Strauss Syndrome Membranoproliferative Glomerulonephritis Source: Harrison's PRINCIPLES OF INTERNAL MEDICINE Eighteenth Edition

Significant problems of the patient. Puffy eyelids (Facial Edema) Bipedal edema Bloody urine Hypertensive 130/80 mmHg. Primary impression : Post Streptococcal Glomerulonephritis. Edema -Most frequent and sometimes the only clinical finding approximately 85% of the patients.

-Usually appears abruptly and first periorbital area, May be generalized. Hematuria -Occurs at onset in 30-50 of children with post streptococcal acute glomerulonephritis.