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Nephrotic syndrome, kidney myopathy, vital signs, unknown allergies, angioedema, asthma. Cardiac evaluation needed?

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Posted on Fri, 1 Jun 2012
Question: 4 yr old female, dx with nephrotic syndrome, kidney myopathy, angioedema, and abdominal bloating. Normal vital signs, unknown allergies, occult blood in UA. Hx of chronic acute asthma.
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Follow up: Dr. Deepak Anvekar (32 minutes later)
Just notified of a correction in medication(s): She is NOT on Albuterol. But she is taking the following meds- Benadryl, Zyrtec, Hydroxazine.
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Answered by Dr. Deepak Anvekar (6 minutes later)
Hello and thanks for the query.

From the history, I assume that your age is in the forties.

Presence of Distended abdomen and occult blood with the present medical history of Nephrotic syndrome, could be a sign of Ascites ( collection of intraperitoneal fluid).

The way ahead would be to do a panel of blood tests including

1. Complete blood counts.

2. Urinalysis ( not needed - if done recently).

3. 24 hrs. urine protein excretion.

4. Renal function tests.

5. Liver function tests.

6. Serum electrolytes.

7. Liver and Renal ultrasound OR a CT scan.

8. Peritoneal tap - and ascitic fluid analysis.

You might consult with a nephrologist or your primary doctor who can do the above tests and treat the underling condition.

You might need a course of treatment with steroids to control the immune related renal damage. In addition, to control the edema, you might benefit by complying with a Renal diet.

I hope the suggestions are helpful.

Please feel free to consult me if you have any doubts.

Regards,

Dr Anvekar.
Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. Deepak Anvekar (13 hours later)
This patient is not in her forties, she is a pediatric pt. age four. Please tell me what could be some of the causes. My research has shown me that this/these type(s) of dx would normally be seen in an adult pt., but could be be seen patients of all ages.

Please know that I am a nurse, I have seen all types of paitents over many years, but never a peds patient that demonstrated ascites in a couple hours.

From what I understand this could lead to CHF, right? If so, could the dx of asthma in her recent past be a misdiagnosis because of the difficulty breathing aspect and a rush to a speedy dx? I am concerned about the cause(s), and what are the questions that I should ask the doctor(s), this pt. is my Granddaughter... My nerves are shot & I can't think right, please help me.
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Answered by Dr. Deepak Anvekar (4 hours later)
Hello Again,

It seemed to me with the history mentioning that the patient having chronic asthma, and the history being limited, I had to make sure about the age.

Hence thanks for clearing the age.

In case you doubt that your grand daughter has CCF, then some of the possible causes could be :-

1. A undiagnosed heart lesion ( Like a Atrial septal defect, Patent ductus arteriosus, Ventricular septal defect or tetralogy of fallot, etc).
2. Severe childhood anemia
3. Cardiac arrhythmias
4. Myocarditis
5. Cardiomyopathy.
6. pericardial effusion - Due to viral Infections

It is in these cases, that she can develop symptoms of shortness of breath, high heart rate, difficulty feeding, Excessive tiredness, poor growth, Altered consciousness, etc.

Though such causes can be mistaken by common people for asthma, it is highly unlikely to be missed by qualified and trained Doctors. The presence of wheezing and predominance of coughing would first give the impression of Asthma.

The predominance of generalized body swelling, shortness of breath, and absence of respiratory obstruction signs indicate more in favor of cardiogenic causes.

But ultimately a complete clinical examination including a cardiac evaluation can pinpoint the exact Diagnosis.

In the current scenario, presence of blood in the urine and generalised body edema (anasarca) and ascites (abdominal bloating)- are indicators of kidney involvement, specifically to Nephrotic syndrome (Minimal change disease).
Respiratory distress in severe cases of nephrotic syndrome can occur, due to either massive ascites and thoracic compression or XXXXXXX pulmonary edema, or both.

For proper diagnosis of the underlying condition and to rule out cardiac causes, additional testing (in addition to those already mentioned previously), include

1. a EKG
2. Echocardiogram and a
3. Chest Xray.

These tests will be sufficient to make a definitive diagnosis.

With regard to treatment, cardiac causes need correction of the cardiac defects if any, diuretics, correction of anemia, etc.

But in case of nephrotic syndrome, treatment with Steroids and supporting medications can help early resolution of the symptoms.

I hope this helps to address your concerns effectively.

Please feel free to consult me if you have any further doubts

Regards

Dr Anvekar.



Above answer was peer-reviewed by : Dr. Raju A.T
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Dr. Deepak Anvekar

General & Family Physician

Practicing since :2003

Answered : 336 Questions

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Nephrotic syndrome, kidney myopathy, vital signs, unknown allergies, angioedema, asthma. Cardiac evaluation needed?

Just notified of a correction in medication(s): She is NOT on Albuterol. But she is taking the following meds- Benadryl, Zyrtec, Hydroxazine.