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Have facial swelling, has plus one albumin in urine, oxallate crystals found. Diagnosis?

i have a 19 years old male patient with facial swelling 2 months ago.the eye lids are swollen other swelling in the body,no history of medical congested neck has plus one albumin in urine,ca oxallate crystals. serum albumin is normal.elevated ALT and AST about 3 folds with negative B AND C viral markers,normal bilirubin.abdominal us revealed no abnormality apart from mild rt pleural effusion .i hope u can help me to diagnose this poor patient
Asked On : Mon, 28 Jan 2013
Answers:  1 Views:  47
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Pathologist and Microbiologist 's  Response
Hello and welcome to HCM,
The symptom of facial swelling especially eye lids is most suggestive of renal/ kidney disease.
Presence of albumin in urine is also suggestive of kidney disease at the level of glomeruli.
Since. the ultrasound of the abdomen is within normal limits there is no organomegaly.
A renal/ kidney biopsy needs to be performed to look at the microscopic changes in the kidney which is causing proteinuria (proteins in urine) and swelling of the face.
You need to consult a nephrologist for clinical biopsy and biopsy.
The elevated levels of AST ans ALT suggest some kind of damage to the liver cells.
A normal level of bilirubin rules out any kind of obstruction of the biliary tract.
Is there history of alcohol abuse in the patient.
Alcoholic liver disease causes damage to the liver cells and elevated levels of AST and ALT.
In order to confirm alcoholic liver disease, gamma glutamyl transferase and 5 nucleotidase need to be done.
Pleural effusion occurs in case of infections (bacterial, tubercular, viral, etc), malignancies, allergies.
Attempt pleural tap if possible for chemical testing and microscopic examination of the pleural fluid.

Thanks and take care
Dr Shailja P Wahal
Answered: Fri, 23 Aug 2013
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