Nephrotic syndrome

1.Preliminary Diagnosis: could be Nephrotic Syndrome with Acute Kidney Injury. The sudden
onset of generalized edema, decreased urine output, proteinuria, and hypoalbuminemia are
indicative of nephrotic syndrome. The presence of free fluid in the abdominal cavity suggests
ascites, which can occur as a result of severe hypoalbuminemia. The acute kidney injury is likely
secondary to the underlying nephrotic syndrome.

2. Differential Diagnosis:
a. Acute Glomerulonephritis: Given the history of recent upper respiratory tract infection and
the presence of hematuria and proteinuria, acute glomerulonephritis should also be considered.
b. Congestive Heart Failure: The presence of bilateral small hydrothorax on chest X-ray,
shortness of breath, and signs of fluid overload could suggest congestive heart failure as a
differential diagnosis.
c. Liver Cirrhosis: The presence of ascites, hypoalbuminemia, and elevated total cholesterol
may raise suspicion for liver cirrhosis as a differential diagnosis.

3. Immediate Management:
a. Diuretics: Initiate diuretic therapy (e.g., furosemide) to help reduce fluid overload and
manage edema.
b. Albumin Infusion: Consider administering albumin to help increase oncotic pressure and
manage hypoalbuminemia.
c. Monitoring: Monitor fluid balance, electrolytes, renal function, and vital signs closely.
d. Consult Nephrology: Seek consultation with a nephrologist for further evaluation and
management of the underlying nephrotic syndrome.

4. Further Investigations:
a. Renal Biopsy: Consider performing a renal biopsy to confirm the underlying cause of
nephrotic syndrome.
b. Echocardiography: To assess cardiac function and rule out congestive heart failure as a
contributing factor.
 c. Liver Function Tests: Evaluate liver function to assess for possible liver involvement in the
patient’s condition.
d. Autoimmune Markers: Consider testing for autoimmune markers to rule out autoimmune-
related kidney diseases.

5. Long-Term Management:
a. Immunosuppressive Therapy: Depending on the underlying cause of nephrotic syndrome,
immunosuppressive therapy may be initiated.
b. Dietary Modifications: Consider dietary restrictions (e.g., low sodium) to manage fluid
overload.
c. Follow-Up Care: Ensure regular follow-up with nephrology for ongoing management and
monitoring of kidney function and disease progression.