Количество принятой жидкости ____1500 мл___________
| № порции | Часы | Относит плотность | Количество мочи, мл |
| 6.00 | |||
| 9.00 | |||
| 12.00 | |||
| 15.00 | |||
| 18.00 | |||
| 21.00 | |||
| 24.00 | |||
| 3.00 |
Дневной диурез - 610мл
Ночной диурез - 290мл
Общий диурез - 900мл
СКФ: расчетным способом по формуле Кокрофта-Голта:
88*(140-возраст в годах)*вес в кг*коэф_
72*креатинин сыворотки в мкмоль/л
Коэффициент: мужчины=1, женщины=0,85.
Инструментальные данные:
УЗИ – правая почка 13,0*5,3 см, толщина паренхимы 1,4 см, однородная, ЧЛС 1,6 см, уплотнена. Левая почка 13,1*5,4 см, толщина паренхимы 1,4см. Заключение: Увеличение размеров почек, застоя мочи и конкрементов нет.
Standard responses for case report
« Acute nephritic syndrome »
| № | ||
| 1. | Complaints and history taking | Conducted sequentially and systematically |
| 2. | Disease symptoms detailing using the additional differential diagnostic questions | All anamnesis (including familial and allergological anamnesis) clarifying questions were asked |
| 3. | Physical examination – General | Conducted sequentially and correctly. Facial, feet and lower leg soft edema were revealed, blood pressure was correctly measured. |
| 4. | Urinary system examination | Kidneys are not palpable. |
| Urine testing results interpretation | Gross hematuria, dysmorphic (glomerular) red blood cells >30 per HPF Proteinuria <3,5 g/day Edema and arterial hypertension – nephritic syndrome | |
| Preliminary diagnosis rationale and statement | Considering the complaints of urinary “meet-washing” like color, edema, association with sore throat experienced 2 weeks ago, acute onset, lacking diseases and factors predisposing to secondary renal involvement, the Preliminary diagnosis:Acute nephritic syndrome. Acute post-infectious glomerulonephritis is highly suspicious. Glomerular filtration rate decrease. | |
| 7. | Laboratory testing plan | Total blood count; urinalysis; daily urinary protein excretion. Blood biochemistry: urea, creatinine, total protein, albumin, glucose, total cholesterol, sodium, ALT, AST; Zimnitsky test, GFR estimation and renal function assessment. С-reactive protein; urinary culture; ASL-O for streptococcal origin verification of the GN – twice with two weekly interval. |
| 8. | Instrumental examination plan | Renal US; ECG, fundoscopy (relative to BP) Nephrologist consult – renal biopsy if indicated |
| 9. | Blood testing results interpretation | Moderate leucocytosis, leuco-formula left shift, ESR elevation; blood biochemistry – creatinine and urea elevation |
| 10. | Urine testing results interpretation (Zimnitsky test) | Daily diuresis 900 ml. Renal concentration function is preserved. |
| 11. | Immunological testing | 1. Acute ASL-O elevation 2. CRP – acute phase inflammatory protein |
| 12. | GFR estimation using Cockcroft-Gault formula and assessment of the renal filtration function. | GFR 72 ml/min, glomerular filtration rate decrease |
| 13. | Renal US results interpretation | Renal size increased (parenchymal edema) |
| 14. | Final diagnosis rationale and statement | Based on clear association with upper respiratory infection (sore throat) experienced 2 weeks ago and confirmed by the elevated ASL-O; presence of the acute nephritic syndrome with acute onset, excluded systemic involvement: Acute nephritic syndrome. Acute post-infectious glomerulonephritis. Glomerular filtration rate decrease. |
| 15. | Therapeutic management plan | Low-salt diet with <2 g daily. Water-intake regimen: urinary output + 500 ml Streptococcus eradication Syndromic therapy (diuretics) Glucocorticosteroids are not indicated |
| Ethiothropic therapy | Cephalosporins administration considering previous treatment with semisynthetic penicillin (e.g. cephotaxim) for 10-12 days | |
| 17. | Diuretics | Loop diuretic furosemide 40 mg orally in the morning with serum electrolyte (K+) levels monitoring |
| 18. | Complications | Acute renal failure, eclampsia and cardiac failure |
| 19. | Patient follow-up | In general, the prognosis is favorable Blood count, urinalysis, serum creatinine to be tested trimonthly for one year Trace proteinuria may persist for several months BP monitoring Acute respiratory infection prevention |
| 20. | Optimal contact with the patient and anxiety elimination | Optimal contact is established. Patient has confidence. All doctor’s questions were addressed. |
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