32 year old male with CKD on MHD

 32 year old male, worker in a electrical industry in Mumbai came to the OPD, on 10/10/21 with acute onset of seizures.

HOPI:

Patient was apparently asymptomatic 3years ago, then he developed pain in loin region for which he went to a hospital in mumbai and was diagnosed with bilateral renal calculi and bilateral stents were placed.

Patient had no problem after that and continued to work.

After 4-5months the stents were removed. 

1 week after removing the stents he again developed pain in his loin. He went to the same hospital and stents were placed again. 

Patient had no problem after that and continued to work.

About 1 year ago he developed multiple scaly, hperpigmented plaques over trunk with generalised necrosis.

Last year he returned to his home town, near nalgonda and started farming.

few months after that his lost his elder brother(due to sudden cardiac arrest according to what patient said), after that he stopped using his medication.

On 10/10/21 (i.e, after 5-6 months after he stopped his medication) he presented with an episode of seizures and was brought to our hospital. He was found to have high creatinine values and was adviced to be on MHD.

From November,2021 he is undergoing 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  right hip which was incidious in onset ,gradually progressive aggrevated on movement and relieved on rest.

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 right hip septic/infective arthritis. 

INVESTIGATIONS

2/12/21

10/1/22

2/2/22

9/2/22

MRI pelvis showing right sided septic/infective arthritis 

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

Inj Metrogyl

Inj Iron Sucrose 100mg in 100 mlNS

T Nodosis

T Livogen po/od

Dialysis:

1st- 3/11/21

2nd-7/11/21

3rd-10/11/21

4th-13/11/21

5th-21/11/21

6th-24/11/21

7th-27/11/21

8th-30/11/21

9th- 3/12/21

10th-8/12/21

11th -16/12/21

12th-19/12/21

13th-23/12/21

14th-27/12/21

15th-30/12/21

16th-5/1/22

17th-10/1/22

18th-14/1/22

19th- 21/1/22

20th-31/1/22

21st-3/2/22

22nd-7/2/22

23rd-9/2/22

One unit of PRBC transfussion on 3/11/21

One unit of PRBC transfussion on 21/11/21.

One unit of PRBC transfussion on 23/12/21

One unit of PRBC transfussion on 3/1/22

Right hip arthrotomy done for septic arthritis.

Tab ciprofloxacin 500mg

Tab Itraconazole 100mg bd

Tab Ultracet bd

Tab pan 40 od

Tab L Carnitine

Physiotherapy

Walking with help of walker