60 old man farmer occupation from Nalgonda presented to the op complaining of lower back pain since a week, reduced appetite, facial puffiness and shortness of breath grade 3 since one week

20 years ago patient had an occupational accident where a bullock cart ran over his abdomen then underwent splenectomy and 4 prbc transfusion

2 years ago while farming he was wounded on the right dorsum of the foot which did not heal completely for nearly 2 years

on investigations low hemoglobin was found to be the main cause for his delayed wound healing and was referred to another Hospital,In Khammam, on further investigations – RFT, USG he was told to have a kidney infection due to SEPSIS from the ULCER.(?AKI due to SEPSIS) whete underwent 2 prbc transfusion prior operating at the wound site

October, 2021 – 

he was apparently alright when he developed-FEVER, COLD, PEDAL EDEMA (PITTING TYPE) , GENERALISED WEAKNESS OF THE BODY.

He was then taken to a hospital in Suryapet where he was diagnosed with chronic kidney disease and hypertension.

INVESTIGATIONS DONE- SERUM CREAT, CBP, USG ABDOMEN & PELVIS, CUE

Treatment given here – injection erythropoietin , tab.nodosis , tab.vitamin D3, tab.neurobion forte, tab.paracetamol

The symptoms subsided in 3 to 4 days. They continued the medication for one and half month and didn’t know whether to refill the medication or not.

DECEMBER,2021–

On 15/12/21 – after couple of days of stoppage of the medication that is a week back he developed – low backache, loss of appetite, SOB grade 3, facial puffiness, pedal edema (pitting type) which is when they presented to the OPD.

Addictions- chronic alcoholic since -40 yrs-90ml/day, chronic smoker since -40 yrs, 1 pack 20beedis/day, stopped 2 months back 

Diet- mixed

Bowel and bladder movements- regular , normal I/o 

Sleep-adequate

Appetite- reduced Pt is c/c/c.

Vitals- BP-150/100MM HG; PR-83BPM; RR-20CPM; TEMP-AFEBRILE

PALOR-PRESENT ;   ICTERUS-ABSENT         ; CLUBBING-ABSENT;    LYMPHADENOPATHY-ABSENT;   EDEMA-PRESENT 1 WEEK BACK, ABSENT NOW.

Pt is skinny and poorly nourished and has dry skin.

CVS- S1S2 HEARD, NO MURMURS, JVP-

RS-BAE+, NVBS +

CNS- NO FND, HMF INTACT

P/A- SOFT, NON-TENDER, BS +

Previous investigations

 ULTRASOUND WHOLE ABDOMEN

IMPRESSION:

*Bilateral Grade IV chronic renal parenchymal changes.

Current imaging and investigations-

 Diagnosis- Chronic kidney disease with hypertension

Treatment- 

 Tab.LASIX 4OMG TID

Tab.NODOSIS 550 MG OD

Tap.SHELCAL 500 MG OD

Tab OROFER-XT OD

Tab.NICARDIA 20MG BD

INJ.ERYTHROPOIETIN 4000 IU S/C

INJ.IRON SUCROSE 1AMP IN 100ML NS

FLUID RESTRICTION<1L/DAY

SALT RESTRICTION <2.4gm/day

Renal replacement therapt dialysis