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4/22/12

NAME:Gopinath AGE:13 years SEX:Male CHIEF COMPLIANTS: C/O Hematuria for the past 2 days. C/O Left loin pain for the past 2 days. HISTORY OF PRESENT ILLNESS: pain.
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H/O Hematuria associated with loin No H/O frequency of micturition.

No H/O intake of any anticoagulants. No H/O edema. No H/O trauma. No H/O fever. No H/O bleeding from other sites of the body. PAST HISTORY: H/O similar episode-1yr back-3daysspontaneously resolved. No H/O TB. No other relevant past history.
4/22/12 FAMILY HISTORY:

PERSONAL HISTORY: Consumes a mixed diet. Normal bladder and bowel habits. GENERAL EXAMINATION: Conscious,oriented,afebrile. Not anaemic,not icteric. No cyanosis,no clubbing, no pedal edema. No generalised lymphadenopathy. VITALS: RR: 14/min,
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PR: 82/min,

OTHER SYSTEMS: CVS: S1,S2 Heard,No Murmurs. RS: NVBS Heard,No added sounds. P/A:Soft,Not tender,No organomagaly. CNS: Clinically Normal. INVESTIGATIONS: BLOOD: Hb:11.2gm%, RBC:3.8million/cu.mm, TC:8800cells/cu.mm,
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DC:P-57%,L-40%,E-3%,

URINE ROUTINE: Albumin:3+,sugar-Nil,Deposits:Field full of RBCS. 24 hrs urine protein-516mg/day. X-RAY ABDOMEN: Normal. USG ABDOMEN: Normal Study. Patient was treated conservatively. On Day 2: Urine Albumin:3+,sugar-Nil, Deposits-Field full of RBCS. NEPHROLOGIST OPINION:
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On Day 5: Since there was no improvement,he was referred to Higher Institute,Madras Medical College,Chennai. At MMC: INVESTIGATIONS: Blood: Hb:12.8gm% TC:7200cells/cu.mm, DC:P-44%,L-55%,E-1% ESR:7mm/hr, Platelet count:3.3lakhs,
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Urea:28mg,

For further evaluation,In Nephrology Department MMC, RENAL BIOPSY was planned. Before that routine COAGULATION PROFILE was done.From this Investigations aPTT found to be prolonged indicating the presence of COAGULATION DISORDER

aPTT-Test:55 sec.,control:28 sec

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DIAGNOSIS:

HEMOPHILIA A

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Hence Renal Biopsy was deffered, thus a MAJOR CATASTROPHY was PREVENTED.
Once the Diagnosis was made,we persue the case retrospectively and revealed the presence of family history. Presence of similar illness in his younger brother which was not revealed during routine history taking at the time of 4/22/12 admission.

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CASE DISCUSSION:
CAUSES OF HEMATURIA

CAUSE
Kidney

MEDICAL CAUSE

SURGICAL

General cause
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Ureter Bladder

Disease of Renal Parenchyma

MEDICAL CAUSES:
GENERAL CAUSES: Bleeding disorders Anticoagulant Drugs Sub Acute Bacterial

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DISEASE OF RENAL PARENCHYMA:

Glomerulonephritis Malignant Hypertension Polycystic kidney Renal Vein Thrombosis Polyarteritis
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SURGICAL CAUSES:
KIDNEY:
Wilms Tumor Hypernephroma Papilloma of Renal Pelvis Hemorrhage
kidney,renal cyst injury into:hydronephrotic

URETER:
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Stone

BLADDER: Acute cystitis Stone Papilloma Carcinoma Trauma PROSTATE: Tubercular prostatitis Bleeding prostatic venous plexus URETHRA: Trauma
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Angioma

TAKE HOME MESSAGE:

OF This case illustrates the IMPORTANCE

ROUTINE SCREENING of the individual before any Invasive Diagnostic Procedure to prevent serious complications. A major part of DIAGNOSIS also relies on the HISTORY GIVEN BY THE PATIENT,so we should try our level best to GET COMPLETE 4/22/12 HISTORY from the patients.

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