Paediatric-History taking & Physical examination of a patient with Nephrotic Syndrome and Proteinuria

Paediatric-History taking & Physical examination of a patient with Nephrotic Syndrome and ProteinuriaCreated OnApril 28, 2020Last Updated OnApril 28, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of a patient with Nephrotic Syndrome and Proteinuria < All Topics Table of Contents History taking: Identification of patient – age, gender. Edema is the most common presentation in 95% of children with nephrotic syndrome Intermittent and insidious onset May progress rapidly or slowly Usually in low tissue resistance areas (eg: periorbital, scrotal or labial) or it may become generalized and anasarca. Edema is pitting and more prominent in the face in the morning and lower extremities in the day. Urine output, frothy urine, hematuria or dysuria. Weight changes Anorexia, irritability Abdominal discomfort (primary peritonitis in nephrotic syndrome) Diarrhea (due to intestinal edema) – onset, duration, frequency, volume, consistency, content. Dyspnea (due to massive ascites or pulmonary edema or pleural effusion) Symptoms of hypertension (headache, vision problems, chest pain) History of preceding infection – fever, skin infection, sore throat, sick contact History of joint pain, stiffness, swelling, photosensitivity rash, mouth ulcer, hair loss, malaise (to exclude SLE) Past medical history – previously known renal diseases, similar illness, hospitalization, infections, heart diseases (to exclude cardiac oedema) Drug history – any traditional medications or nephrotoxic drugs Family history – renal disease, genetic disorders and autoimmune diseases. Immunization history – hepatitis B Nutrition history – protein intake, diet Other history as indicated – Birth history and Developmental history. Physical examination: General well-being – well or ill-looking child, pallor, jaundice, cyanosis or respiratory distress, size of child and nutritional status Vital signs – blood pressure, pulse rate, respiratory rate. Hypotension and signs of shock can be present if patient is hypovolemic due to fluid loss intravascularly. Hypertension is more common in patient with focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis and nephritic syndrome Assess the hydration status Hypovolemia: cold periphery, poor capillary refill, poor pulse volume, low blood pressure Hypervolemia;...

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