Long case

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32 YEAR OLD MALE WITH CKD ON MHD

32 year old male, worker in an electrical industry in Mumbai came to the OPD, with hip pain.

History of present Illness :

Patient was apparently asymptomatic 3years ago, then he developed pain in loin region for which he went to a private hospital in mumbai and was diagnosed with bilateral renal calculi and bilateral stents were placed (patient attender said that there was no problem in kidney function at that time). Patient had no problem after that and continued to work.

After 4-5months the stents were removed, just 1 week after stents were removed patient again had pain in his loin. He was taken to the same hospital and bilateral stents were again placed. (Patient attender said his s.creatinine values were 3-4 mg/dl, this time). Patient had no problem after that and continued to work.

About 1 year ago he developed multiple scaly, hyperpigmented plaques noted over trunk both groins and inner thighs, generalised necrosis (+).

Last year he returned to his home town, near nalgonda and started farming, few months after that he lost his elder brother(due to sudden cardiac arrest according to what patient said), after that he stopped using his medication.

After 5-6 months after he stopped his medication he presented with right hip pain and was brought to our hospital. He was found to have high creatinine values and was adviced to be on MHD.

From then he underwent 20 sessions of dialysis ( 2 sessions per week).

2 months ago he had severe bleeding from his AV fistula on left arm and then it was sutured. From then he has difficulty in his left forearm and hand movements 

Since 1 month he is complaining of severe pain in his right hip and was unable to even get up from chair.

No c/o sob, facial puffiness, chest pain, palpitations, giddiness, decreased urine output, burning micturition.

PAST HISTORY-

Known case of Diabetes mellitus, was on Tab.Glimy M2 OD, but stopped using it after stents were placed.

Known case of Hypertension and on

T.LASIX 40mg PO BD

T. NODOSIS 500 MG PO BD

T. OROFER-XR PO OD

He was married 7 years back and doesn't have children. Did not consult any doctor regarding infertility. 

PERSONAL HISTORY -

Sleep- Adequate 

Appetite- normal

Diet- mixed

Bowel movement- Regular

Addictions- nil

On examination

Pt is C/c/c

Pallor ++

No Icterus ,Cyanosis, Clubbing,Lymphadenopathy

Edema of feet + 

Vitals

Pr:88bpm

Bp:120/90

Spo2:97% at RA

Temp - Afebrile

Grbs - 166 mg/dl

SYSTEMIC EXAMINATION -

CVS - S1,S2 +

RS - BAE + 

CNS - NAD

P/A- Soft, non tender

INVESTIGATIONS-

Serology - Negative

PROVISIONAL DIAGNOSIS - 

B/L Multiple renal calculi largest measuring 13mm in right and 10 mm in left with B/L hydrouretronephrosis, Obstructive uropathy with tenia corposis et crusis with h/o Hypertension and Diabetes mellitus with hip pain under evaluation 

TREATMENT-

Fluid restriction (<1.5l/day)

Salt restriction (<2g/day)⁸

T· LASIX 40 mg PO BD

T. NICARDIA 10MG PO BD

Inj. ERYTHROPOIETIN 4000IU SC weekly once

ZODERM CREAM L/A BD

Dialysis - weekly 2 sessions 

INVESTIGATIONS