Tadala is a 14 year old girl initially thought to have nephrotic syndrome. Nephrotic syndrome leads to massive swelling of the legs, abdomen and around the eyes. It is caused by the loss of large amounts of protein in the urine. The volume of blood is not increased and high blood pressure is not usually seen. In the developed world, nephrotic syndrome is not uncommon and is frequently treated with steroids and diuretics with good resolution. In Africa, there are many other causes for this kind of body swelling including strep infections in the throat and skin, leprosy, malaria, drugs, HIV nephropathy, connective tissue diseases such as lupus, schistosomiasis, heart failure, cirrhosis and hepatitis B. Tadala presented with edema; puffy eyes and swollen legs and stomach disfiguring her face and making it difficult for her to walk. She was admitted to the hospital weighing 41 kgs and treatment was started with Lasix and Prednisolone for presumed nephritic syndrome. When a urinalysis was obtained however there were many red blood cells and only a small amount of protein. Additionally when I took her blood pressure it was elevated at 170/130. She was complaining of headache. It seemed she had glomerulonephritis with malignant hypertension not nephrotic syndrome. There was no history of strep or skin infection. During the two weeks she was in the hospital she received a combination of four different blood pressure medications; Lasix, Hydralazine, Nifedipine and Aldomet to control her blood pressure. Due to electricity outages we were unable to initially obtain any blood tests. When we did they showed acute renal failure with a creatinine of 5.2 and potassium which remained below 6.5. We talked with her family about limiting bananas, restricting fluids and not salting the relish she ate with her nshima. Slowly, slowly (pong’ono pong’ono) as her blood pressure improved her kidney function began to return toward normal. Her weight dropped 7 kilograms or 15and ½ pounds. The day the edema disappeared from her legs and face she began to smile in a shy happy way whenever we looked her way. Her mother and grandmother thanked us effusively and I reminded them that we are only servants of God. We must all thank God for his faithfulness. “Mulungu akukuchizani” God has healed her!
Tadala is a 14 year old girl initially thought to have nephrotic syndrome. Nephrotic syndrome leads to massive swelling of the legs, abdomen and around the eyes. It is caused by the loss of large amounts of protein in the urine. The volume of blood is not increased and high blood pressure is not usually seen. In the developed world, nephrotic syndrome is not uncommon and is frequently treated with steroids and diuretics with good resolution. In Africa, there are many other causes for this kind of body swelling including strep infections in the throat and skin, leprosy, malaria, drugs, HIV nephropathy, connective tissue diseases such as lupus, schistosomiasis, heart failure, cirrhosis and hepatitis B. Tadala presented with edema; puffy eyes and swollen legs and stomach disfiguring her face and making it difficult for her to walk. She was admitted to the hospital weighing 41 kgs and treatment was started with Lasix and Prednisolone for presumed nephritic syndrome. When a urinalysis was obtained however there were many red blood cells and only a small amount of protein. Additionally when I took her blood pressure it was elevated at 170/130. She was complaining of headache. It seemed she had glomerulonephritis with malignant hypertension not nephrotic syndrome. There was no history of strep or skin infection. During the two weeks she was in the hospital she received a combination of four different blood pressure medications; Lasix, Hydralazine, Nifedipine and Aldomet to control her blood pressure. Due to electricity outages we were unable to initially obtain any blood tests. When we did they showed acute renal failure with a creatinine of 5.2 and potassium which remained below 6.5. We talked with her family about limiting bananas, restricting fluids and not salting the relish she ate with her nshima. Slowly, slowly (pong’ono pong’ono) as her blood pressure improved her kidney function began to return toward normal. Her weight dropped 7 kilograms or 15and ½ pounds. The day the edema disappeared from her legs and face she began to smile in a shy happy way whenever we looked her way. Her mother and grandmother thanked us effusively and I reminded them that we are only servants of God. We must all thank God for his faithfulness. “Mulungu akukuchizani” God has healed her! 
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