A clinical case of edematous syndrome: diagnostic search and treatment tactics of a complex patient in compliance with the internarial and domestic recommendations

Abstract

Edematous syndrome is quite common in modern clinical practice. Swelling is one of the most common complaints that cause the patient to consult a doctor and often become the first clinical manifestation of many diseases. Fluid makes up approximately 3/5 of the human body weight, 70% of which is located in cells, and about 30% is extracellular. There is a constant exchange of electrolytes and other substances involved in metabolism between the cell and the extracellular fluid. Subcutaneous connective tissue under normal conditions contains a minimal amount of fluid. Edema fluid formed from blood plasma, which in pathological conditions under the influence of various factors is unable to retain water in the vascular bed, and water accumulates in excessive amounts in the tissues. Often, a patient refers to a doctor with the main complaint — the appearance of edema, and the correct interpretation of the origin of edema is important at this stage, because they are often a marker that reflects the severity and/or decompensation of the disease. Therefore, a detailed and comprehensive differential diagnosis of the edematous syndrome allows choosing the optimal tactics of the patient’s treatment.
 The authors present a clinical case of diagnostic search and treatment tactics for edematous syndrome based on global and national recommendations. Patient V., 1983 year of birth, on May 8th, 2023, visited a nephrologist at the L. T. Mala National Therapy Institute. She believed that kidney disease caused swelling of her face and lower limbs. However, considering the long history of intestinal dysfunction, protein loss and edema, the case was revised as a manifestation of gastroenterological pathology. The patient was referred to a gastroenterologist. An extensive diagnostic search was conducted, which allowed not only to establish the correct diagnosis, but also to administer an effective therapy.