A case of CKD

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A 64 yr old male who is a resident of nalgonda farmer by occupation came to the opd with the chief complaint of NO URINATION SINCE 3 days . 

HISTORY OF PRESENTING  ILLNESS

Patient was apparently asymptomatic 4 years back 

Later He developed  PAIN ABDOMEN  and TIGHTNESS 

and came to hospital for which he was diagnosed as having RENAL CALICULI and underwent Percutaneous nephrostomy 

in our hospital and later discharged . Later he developed GENERALISED WEAKNESS and DIZZINESS  for which he was diagnosed as DIABETES MELLITUS TYPE 2 and HYPERTENSION 2 years ago. On irregular medication 2 yrs back ( 2020 Nov )  on being unresponsive and was in ICU for 4-5 days and diagnosed to be hypoglycaemic and creatinine is 5.94 , denied for dialysis and discharged. Pedal edema was on and off and no decreased urine output , no hematuria . 

Fever associated with loose stools 10 days back , with decreased urine output for 1 day and anuria for 3 days  taken to the hospital and underwent 4 sessions of hemodialysis and came here for hemodialysis . 

                        

                          

                           

        

PAST HISTORY 

2 years ago he was diagnosed as having RENAL CALICULI and underwent PCN . 

K/C/O Diabetes mellitus since 2 years 

K/C/O Hypertension since 2 years 

N/K/C/O Asthma , Tuberculosis , epilepsy 

PERSONAL HISTORY 

Appetite - lost 

Eggetarian 

He has diarrhoea 

Micturition - abnormal ( Anuria )

 HABITS 

Alcohol- occasionally 

Tobacco - smoking chutta 

GENERAL EXAMINATION 

Pallor - Present 

Icterus - absent 

Cyanosis- absent 

Clubbing- absent 

Lymphadenopathy- absent 

Edema - present ( Anasarca ) 

             

               

VITALS : 

Temperature – 101°F 

Pulse rate –106 per min 

BP –160/90 

Respiration rate –

GRBS – 177mg % 

SPO - 96 percent

GRBS - 177mg%

SYSTEMIC EXAMINATION 

    CVS 

No Thrills 

Cardiac sounds S1,S2+

No murmurs 

RESPIRATORY SYSTEM 

Dyspnoea - present 

Wheeze - absent 

Position of trachea - central 

Breath sounds are vesicular

ABDOMINAL EXAMINATION 

Abdomen is obese 

No Tenderness 

No palpable mass 

Hernial orifices normal 

No free fluid 

No bruits 

Liver is not palpable 

Spleen is not palpable 

Bowel sounds heard 

CNS 

 Conscious

Speech is normal 

Signs of meningeal irritation- no neck stiffness

                                                 Kernings sign negative 

Cerebral signs - No finger nose in coordination 

                           No knee-heel in coordination 

PROVISIONAL DIAGNOSIS 

   Chronic renal failure with  

T2 DM and HTN 

Investigations 

       

         

    

    

  ULTRASOUND  

   

    

  

       

    
       

           

             

      

     

     

      

    

    

     

   TREATMENT

    1)salt restriction< 1 to 2 gm/day

2)fluid restriction < 2L/day

3) inj LASIX 40 mg IV BD 

4) tab .NICARDIA 10mg PO BD

5)tab.NODOSIS 500mg PO BD

6)tab. SHELCAL 500Mg PO OD

7)tab. OROFER-XT  PO OD

8)inj.erythropoetin 4000IU

9) haemodialysis , 

Antibiotics after culture

on 5/7/22 

BP: 100/70 mm of Hg 

PR:77 bpm 

RS: 18 Cpm 

CVS : SI and S2 Normal

CNS: NAD

per abdomen: soft and non tender

6/7/22

BP:90/60 Mm Hg

PR:86 bpm

C VS:SI,S2 +

C NS :NAD 

per abdomen:softand non tender

Treatment

Inj Lasix40mg IV Bd

Tab. Nicardia

T. Nodosis

T. Shelcal 

T. Orofor

T. Dolo

7/7 / 22 

BP:110/60 mm Hg

PR:80 bpm

C V S :SI,S2 +

CN S:NAD

per abdomen:soft and nontender

Treatment

Inj Lasix 

Tab. Nicardia

T. Nodosis

T. Shelcal

T. Orofer

T.Dolo