Odewole K., 13

Odewole khadijat is the 3rd born into a family of 6, living in a rented apartment of a room and parlor, her father died 2months ago while the mother is a trader and she earn 25,000 monthly from her trade business. Patient was apparently in her usual state of health until over a month ago when she was noticed to have facial swelling which was insidious in onset and worsen progressively, she was subsequently noticed to be having abdominal and bilateral leg swelling days after. She fainted a month and the fainting episode was said to have lasted for about 10 minutes. She then started having nocturia, easy fatigability andf early satiety. She presented with facial puffiness, bilateral leg edema up to the thigh region, bilateral renal angle tenderness, orthopnea and abdominal swelling. On presentation at our hospital, Khadijat was evaluated and diagnosed with chronic kidney disease and congestive cardiac failure. She requires immediate medical attention.

She was assessed and investigated, Echocardiography done revealed Congestive cardia failure and findings in keeping with moderate pericardial effusion with imminent cardiac tamponade. Abdominal specialist scan done revealed bilateral renal parenchyma disease grade 2 with EUCR revealing deranged values of urea and creatinine ( 23 on a reference range of 2.1-7.1mmol/L for urea and 864 on a reference range of 60-120 for creatinine). Management commenced as a case of A/CKD and pericardial effusion. She was placed on IV Diuretic, IV Antibiotics , hematinics and Oral anithypertensives because of the elevated blood pressure. She was reviewed by an Ophthalmologist on account of myopia. Serology test indicate a positive result for Hepatitis B and so could not have hemodialysis at this centre. Facial and leg swelling has reduced remarkably, and she was discharged on oral medications.

Khadijat's complaints, symptoms and investigations done revealed a coexistence of chronic kidney disease and moderate pericardial effusion with imminent cardiac tamponade makes patient condition complex. Patient needs a multidisciplinary approach of care involving pediatric specialist (Nephrology, cardiology) dialysis to help renal function, close monitoring especially of the cardiological/ renal signs. The prognosis and outlook can be favorable based on prompt medical management and specialist input and routine follow up.