A case of diabetic nephropathy

This is online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputsThis e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome.

A 22 year old woman presented to op with 
Cheif complaints of : 
              bilateral pedal edema since 1 month
              Shortness of breath since  1 month
              Decreased urine output since 10 days
              Swelling of lips and face. Since 2 days
HISTORY OF PRESENT ILLNESS :
  patient was asymptomatic 1 month back then she developed pedal edema upto knees then she was taken to a local hospital for treatment 
 HISTORY OF PAST ILLNESS : 
 patient was diabetic since 11 years
                       Hypertension since 6 months
     No TB , Asthma ,
 DRUG HISTORY : 
 No allergies to known drugs
PERSONAL HISTORY : 
   Patient is married ,housewife
   Appetite lost
   Bowels irregular
    Micturition abnormal
FAMILY HISTORY : 
    No significant family history
GENERAL EXAMINATION :
    Patient is conscious coherent and coperative   
    pallor
    No cyanosis ,  no icterus
    No clubbing of fingers
    No lymphadenopathy
    Edema
    Ascites moderate
Vitals :
    Temp : 98.5°F
     PR : 91/min
     RR : 18/min
     BP : 170/90
GRBS : 254mg%
SYSTEMIC EXAMINATION :
  - Respiratory system:
       Decreased breath sounds
 - CVS :
        S1 and S2 are heard 
         No murmurs
PROVISIONAL DIAGNOSIS : 
 Nephrotic syndrome with Diabetic nephropathy with CKD
INVESTIGATIONS : 
   * Ultrasound Report : 
     Liver - normal
     Pancreas - atrophic
     Gallbladder - distended
     Spleen - normal
     Kidneys - increase in size
     Moderate ascitis
     Urinary bladder - partially distended
   IMPRESSION :
    - increase in size of kidneys
    - moderate ascitis
    - gall bladder sludge with multiple hyperchromic         foci
    - moderate pleural effusion (R)
    - moderate pleural effusion with collapse of                underlying lung(L)
    - diffuse subcutaneous edema noted all over the         abdomen
  * Colour Doppler 2D echo :
      Valves - normal
      Right atrium and ventricle - normal
      Left atrium - mild dilated 
      Left ventricle - concentric LVH (+)
      Pulmonary arteries and veins - normal
      Pericardium : minimal pleural effusion
      IVC : mild collapsing
 TREATMENT : 
   1. Head end elevation upto 30°   
   2. IVF - NS (urine out5 - 30ml /hr)
   3.Inj . PANTOP 40 mg/IV/ OD
   4. INJ. ZOFER 4mg/IV/BD
   5.salt restriction <2.4gm/day
   6.fluid restriction <1lit/day
   7. INJ.HAI s/c pree - meal (10units)
   8. INJ.LASIX 40 mg/IV/TID
   9. Monitor vitals daily
   10. Tab. NICARDIA 10mg/ TID
      

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