2 years old boy with Neph...

Patient B, a boy, 2 years old, presented with a chief complaint of swelling since 2 weeks ago. Swelling was complained of on both limbs and both eyelids which were mainly found to be heavier when waking up. The abdomen was also said to be enlarged. There were no complaints of shortness of breath, either during activity or at rest, and no fever. There was no previous history of similar complaints. Physical examination revealed compos mentis, stable vital signs. Anthropometry weight 15 kg, height 88 cm, upper arm circumference 13 cm. Palpebral edema, pretibial, shifting dullness (+). Anamnesis obtained: Swelling in both eyelids, abdomen, legs, or whole body that may be accompanied by decreased urine output. There may be complaints of cloudy urine or hematuria. Physical examination: Edema in both eyelids, limbs Assistes Scrotal/labia edema Sometimes hypertension can be found. Supporting examination: Complete urinalysis with massive proteinuria (+≥ 2), urine albumin-creatinine ratio >2, may be accompanied by hematuria. Hypoalbuminemia (<2.5g/dL) May be accompanied by hypercholesterolemia (>200 mg/dL) Elevated ESR Renal function (Ur, Cr) is generally normal unless there is a decrease in renal function the patient was diagnosed with initial nephrotic syndrome.