32 year old man,electrician by occupation in mumbai came to OPD 4 months back with acute onset of seizures.
HOPI:
patient was apparently asymptomatic 3 years back and then he developed pain in the loin region for which he went to private hospital in Mumbai and he was diagnosed with bilateral renal caliculi and bilateral stunts were placed.
After 4 to 5 months stunts were removed,after 1 week of removing stunt again he started developing pain in the loin region. He was taken to the same hospital and bilateral renal stunts were placed again.
1 year ago he started developing multiple scaly,itchy, hyperpigmented lesions over the trunk,inner thigh and groin.
Last year he returned to the hometown near Nalgonda, and started farming. He stopped using his medications few months after he lost his brother due to cardiac arrest.
3months ago he presented with an acute episode of seizures which lasted for 15 minutes. He was then bought to our hospital. He was found to have high creatinine value and advised to be on MHD.
From then he is undergoing 2 sessions of dialysis 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 left forearm and hand movements.
Since one month he is complaining of severe pain in his right hip .
No history of sob,facial puffiness,chest pain,palpitations ,giddiness, decreased urine output, burning micturation.
PAST HISTORY:
Known case of diabetes
Tab.Glimy M2 OD, now on insulin
Known case of hypertension
TAB LASIX 40mg PO OD
TAB NODOSIS 500mg PO OD
TAB OROFER XR PO OD
PERSONAL HISTORY :
Sleep - adequate
Appetite-normal
Diet-mixed
Bowel and bladder-regular
Addictions- nil
On examination
Pt is C/c/c
Pallor ++
No Icterus ,Cyanosis, Clubbing,Lymphadenopathy,
Edema of feet +
VITALS:
Pr:88bpm
Bp:120/90mm of Hg
Spo2:97% at RA
Temp - Afebrile
Grbs - 166gm/dl
SYSTEMIC EXAMINATION
CVS - S1,S2 +
RS - BAE +
CNS - NAD
P/A- Soft, non tender
INVESTIGATIONS
Serology - Negative
PROVISIONALDIAGNOSIS
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.
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
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