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Med Surg Case Study #12

Presenting Complaint: Sarah, a 32-year-old female, presents to the clinic with complaints of generalized swelling (edema) in her face, legs, and abdomen for the past few weeks. She mentions feeling increasingly fatigued and has noticed foamy urine in the mornings. Sarah denies any recent illnesses or changes in her diet or lifestyle.

Patient Background: Sarah has a history of systemic lupus erythematosus (SLE) diagnosed five years ago. She manages her condition with prescribed medications, including corticosteroids and immunosuppressants. She has a family history of autoimmune disorders but no history of kidney disease. Sarah works as a teacher and leads an active lifestyle.

Assessment: Upon physical assessment, Sarah appears fatigued and has noticeable periorbital edema and bilateral pedal edema. Her blood pressure is within normal limits. Laboratory tests reveal elevated levels of protein in the urine (proteinuria) and decreased serum albumin levels.

1. Based on Sarah's history and assessment findings, what is the possible diagnosis for his condition?

2. What diagnostics might be used to confirm the diagnosis?

3. What treatments might be needed for Sarah's condition?

See answers below

Med Surg Notebook


1. What are the possible diagnoses for Sarah's condition?

Nephrotic Syndrome, a constellation of symptoms characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia due to glomerular dysfunction.

2. What diagnostics might be used to confirm the diagnosis?

Diagnostic tests:

  • Urinalysis to confirm and quantify proteinuria.

  • Serum albumin and lipid profile tests to assess hypoalbuminemia and hyperlipidemia.

  • Kidney function tests including serum creatinine, blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR).

3. What treatments might be needed for Sarah's condition?

Possible treatments may include management of the underlying cause, such as adjusting medications for lupus nephritis and potentially increasing immunosuppressive therapy. Diuretics to manage edema. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to control proteinuria and protect kidney function. (They work by dilating blood vessels, reducing protein leakage from the kidneys, and helping to protect kidney function.) Dietary modifications to control hyperlipidemia and limit sodium intake to manage fluid retention.

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