CASE REPORT

Name Sex/Age Adress Tribe Religion Marial status Last education Register Admission time

: Mrs.A : Female/44 y.o : Sungai buntu RT/RW 01/08 : Sunda : moeslim : married : Primary school : 389329 : March 21 2011

Chieft Complaint
Swelling of the entire body since 1 months before amission

Additional Complaint
Difficulty of breathing Difficulty to move Feel weak

Swelling of the entire body since 1 months before admission, initially develops around ankle and foot, and then become generalized. Swelling is constant throughout time. No sign of redness and warm of the swelling.

Felt difficult to breath uninfluence by position, activity.

Patient urinate 2-3 times per day,the color is not clear, no history of dysuria, hematuria. Negative history of nausea, vomiting, and fever.

History of previous disease with the same disease (-) History of hypertension (+) No history of diabetes mellitus,asthma,food/drug allergy

No family member with the same symptoms History of hypertension (+) No history of diabetes mellitus,asthma, food allergy

No drug use in long term

General Condition consciousness

Moderate illnes

Compos mentis

Vital sign

BP 150/80;Temp 36.9C;RR 24x/menit;pulse 100x/menit

Head - facial swelling (+) - conjungtiva anemic (-/-) - sclera icteric (-/-)

Neck - lymph glands not palpable - Thyroid gland not palpable - central trachea - JVP 5+2cm

Heart - I: ictus cordis is unseen - P: ictus cordis palpable on 5th ICS and 1 cm left medial of left midclavicular - P: normal heart border - A: S1 &S2 regular, S3 (-),S4(-), murmur (-),gallop(-) Pulmo - I : symetrical - P :equal vocal fremitus - P :sonor - A : vesicular, ronchi (-),wheezing (-)

Abdomen
Ins : protuberant , smiling umbilicus (+) Aus : bowel sound (+) normal Pal : soft, no hepar/spleen enlargement,undulation (+) Per : shifting dullness (+), CVA tenderness (-)

Extremities
Pitting edema warm

Test Hb
Leukosit Trombosit Hematokrit Gds Ureum Creatinin SGOT SGPT Bil direct Bil indirect Cholesterol total Protein total

Result 12.1
11.500 211000 37 180 84.7 2.52 19 9 0.46 0.26 312 4.42

Normal 12-17%
5000-10000 150000-450000 37-48% 80-140 10-45 mg/dl 0.4-1.5mg/dl 0-34 0-40 <0.6 <0.4 <200 6.1-8.2

Urine colour : turbid yellow ph : 6.5 Protein : (+) 2

44 y.o woman came with chief complaints swelling of the entire body since 1 months before admission, initially develops around ankle and foot and then becomes generalized. Swelling is constant throughout time. Feel difficult to breath,move and feel weak.

Physical examination, facial swelling (+), protuberant abdomen, smiling umbilicus,undulasi (+), shifting dullness (+), pitting oedem

Laboratory findings march 21 2011 -ureum :84.7,g/dl; creatinin : 2.52 mg/dl; albumin 1.59 ;cholesterol total 312; protein +2

Differential diagnosis - nephrotic syndrome -glomerulonephritis - sirosis hepatis - CKD - CHF Working diagnosis - nephrotic syndrome

Lasix 60mg/day Albumin 20% 100 cc Captopril 12.5 mg x2 Simvastatin 5mgx 1 Valsartan 40mgx2 Metilprednisolon 240mg/day iv Angioten 1x50mg

USG abdomen EKG

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