《儿科学》课程作业习题（典型病例）06 anute nepheritis-1

Medical number: 663648Main Diagnosis: Acute Poststreptococcal Glomerulonephritis (APSGN)History summaryBoy, 10-year-old.2.Onseturgent,ashort duratione and eyelids for foMain clinical presation:eyelid,face and double lower limb edema, especially in the earlymorningWithout obviousoliguriaand nogross heamaturiaNofaint, headache,disregardowagueand twitching,no palpitations, nausea,novomitand bellyacheHad a sore throat 6 days before without feverNopartnal historPhysical Examination (PE):T36.5C,R 20bpm, HR 90bm, BP130/110mmHg, Wt 50.0KgConscious, quiet with eyelids and face edema. Tonsils II°swelled without secretion. Noabnormal sign wvas present in the lung and heart. The abdomen is soft, the liver and spleen cannot be touched undeder rib, no pain in thekidney area.Double lower limbs mild edema, notholle8.Lab()Routineblodtests:WBC0.05×19/0.770.21RBC4.24x2/122g/LPLT284×10^9/L,CRP12mg/L.(2) Routineurine test:Bld3+rotein+,RBC+++/HP24hurine proteinquotag(3)12-hourAddiscounting:RBC19200000/12h(0-500000),WBC520000/12h(put exempt determination): β2-MG52.54ug/h THP 55.8mg/h.4)TheIgG>50mg/,A1b>50mg/l(5) Antistreptolysin O titer (ASO) (latex technique)> 200IU/ml (<200IU/m), C3 0.31g/(normalreferencescope0.6-1.5)(6)BUN9.43mmol/l(normalreferencescope2.87-7.14mmol/l)(7) Kidney ultra:y aortabloodstreamspeed measuredtes slightly, thenanobviouslyexceptionally(8) ECG: the left atrium and left ventricle expand slightlyTreatment:I, Bed-rest, light diet, monitoring blood pressure.Use cefoxitin to clear out bacteriasalvia miltirrhiza alkone to improve blood supply ofkidne3.Captopril and nifedipine to control the blood pressure;hydrochlorothiazide to promotediuresis.OutecomeAfter 7-day hospital treatment, edema relived, urine bcame clear, the blood pressureased to normal.PE:Blood pressure110/80mmHg,face,eyelids and lower limb donotlecrehave edema. Test of BUN is normal2.Can do mild exercise and go to school when the Erythrocyte Sedimentation Rate is normal.Avoidmovingfiercely in 3months and can live a normalife when Addis count comesnormal

Medical number: 663648 Main Diagnosis: Acute Poststreptococcal Glomerulonephritis (APSGN) History summary: 1. Boy, 10-year-old. 2. Onset urgent, a short duration. 3. Main complaints: edema of face and eyelids for four days. 4. Main clinical presentation: eyelid, face and double lower limb edema, especially in the early morning. Without obvious oliguria, and no gross heamaturia. No faint, headache, disregard of vague and twitching, no palpitations, nausea, no vomit and bellyache. 5. Had a sore throat 6 days before without fever. 6. No particular personal history. 7. Physical Examination (PE): T36.5℃, R 20bpm, HR 90bpm, BP130/110mmHg, Wt 50.0Kg. Conscious, quiet with eyelids and face edema. Tonsils II°swelled without secretion. No abnormal sign was present in the lung and heart. The abdomen is soft, the liver and spleen can not be touched under rib, no pain in the kidney area. Double lower limbs mild edema, not hollow. 8. Lab Examination: (1) Routine blood tests: WBC10.05×10^9/L，N 0.77 L 0.21，RBC 4.24×10^12/L Hb 122g/L PLT 284×10^9/L CRP12mg/ L. (2) Routine urine test: Blood 3+, protein 1+, RBC+++ /HP. 24h urine protein quota 0.33g. (3) 12-hour Addis counting: RBC 19200000/12h (0-500000), WBC 520000/12h. (4) The urine proteins (put exempt determination): β2-MG52.54ug/h, THP 55.8mg/h, IgG>50mg/l, A1b>50mg/l. (5) Antistreptolysin O titer (ASO ) (latex technique)> 200IU/ml (<200IU/ml), C3 0.31g/l (normal reference scope 0.6-1.5). (6) BUN9.43mmol/l (normal reference scope 2.87-7.14mmol/l). (7) Kidney ultra: kidney aorta blood stream speed measured the value decreases slightly, the shape has not seen obviously exceptionally. (8) ECG: the left atrium and left ventricle expand slightly. Treatment: 1. Bed-rest, light diet, monitoring blood pressure. 2. Use cefoxitin to clear out bacteria, salvia miltiorrhiza alkone to improve blood supply of kidney. 3. Captopril and nifedipine to control the blood pressure; hydrochlorothiazide to promote diuresis. Outcome: 1. After 7-day hospital treatment, edema relived, urine became clear, the blood pressure decreased to normal. PE: Blood pressure 110/80mmHg, face, eyelids and lower limb do not have edema. Test of BUN is normal. 2. Can do mild exercise and go to school when the Erythrocyte Sedimentation Rate is normal. Avoid moving fiercely in 3 months and can live a normal life when Addis count comes normal