45 years old female with reduced urine , facial puffiness and SOB.

​THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE - IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT .HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT."

45 year old female patient came to OPD with c/o reduced urine output since 1 week,easy fatigabiility from 1 week and sob since 3 days and facial puffiness since 1 week.

She is a daily wage labourer and she stopped working 3 years back because she would easily get tired. 

1 year back she experienced severe right loin pain along with reduced urine output and generalized anasarca. 

She underwent right DJ stenting and also 3 sessions of hemodialysis

She didn't undergo hemodialysis or wasn't on any treatment for 1 year due to the COVID pandemic. 

1 week back, patient started experiencing reduced urine output and would easily get tired. She also told us that she noticed facial puffiness 1 week back. She also started feeling dyspneic after walking a few steps since 5 days, though it wasn't associated with any orthopnea, PND, chest pain, palpitations. Also no complaints of cough, wheeze.

General Examination:

Patient was a moderately built individual, with pallor  and facial puffiness 

No icterus, cyanosis, clubbing, koilonychia, lymphadenopathy.

Vitals at admission:

PR- 80 bpm

BP- 130/70 mmHg

RR- 22 cpm

SpO2- 98% 

GRBS -116 mg/dl

CVS: S1 S2 +,

RS: B/L AE +

P/A: soft nontender 

Diagnosis:

 B/L groin hydroureteronephrosis 

B/L ureteric calculi 

Post right sided DJ stenting 

Investigations:

BGT: B positive 

Serology: negative 

XRAY

N

USG 

Right kidney 

2D ECHO

NCCT KUB FINDING @ 17/02/22

 

Plan of treatment :

1. INJ. LASIX 40 mg IV BD

2. INJ PAN 40 mg IV OD 

3. INJ ZOFER 4 mg IV OD

4. INJ erythropoietin 4000 IU SC once weekly

5. Tab NODOSIS 500 mg PO BD

6. Tab OROFER XT PO OD

7. Tab SHELCAL PO OD

8. MONITOR VITALS

Post dialysis, she had episodes of vomitings, decreased intake of food and hypoglycemia. After 2-3 sessions , no episodes of vomiting occured. 

Till date the patient has undergone 9 dialysis sessions over a stay of about 1 month in the hospital. 

Plan of urology : Removal of the displaced DJ stent and renal stones and place another one after reducing creatinine levels.