POLYCYSTIC KIDNEY DISEASE STAGE V CHRONIC KIDNEY DISEASE ANEMIA SECONDARY TO CKD K/C/O PULMONARY KOCHS 30 YEARS AGO DM+,HTN+

 Case History and Clinical Findings

C/OINVOLUNTARY MOVEMENTS ALL OVER THE BODY SINCE 4DAYS

HOPI:PT WAS APPARENTLY ASYMPTOMATIC ALRIGHT 7 DAYS BACK THEN DEVELOPED SOB AND HEAVENESS OF CHEST FOR WHICH HE WAS ADMITTED AND GOT TREATED THEN AFTER HE WAS DEVELOPING INVOLUNTARY MOVEMENTS OF ALL OVER THE BODY PROGRESSING IN INTENSITY

NO H/O TRAUMA TO HEAD

NO H/O INVOLUNTARY FALLS

NO H/O SPIPPAGE OF SLIPPERS

NO H/O DIFFICULTY IN COMBING,NO H/O DIFFICULTY IN CHEWING

NO H/O SQUINT,ANOSMIA,PAROAMIA,HICCUPS,DYSPHAGIA,ABDOMINAL PAIN,VOMITINGS,DIARRHOA

K/C/O AD PCKD ,TB 30 YEARS BACK

DM SINCE4YEARS ON GLIDAZIDE 80MG

HTN SINCE 2 YEARS

GENERAL EXAMINATION:

PT IS C/C/C

BP-140/80

PR-86BPM

SPO-99

SYSTEMIC EXAMINATION

CVS-S1S2+

RS-NVBS

CNS-NFND

P/A-SOFT NON TENDER

PROVISIONAL DIAGNOSIS


POLYCYSTIC KIDNEY DISEASE

STAGE V CHRONIC KIDNEY DISEASE

ANEMIA SECONDARY TO CKD

K/C/O PULMONARY KOCHS 30 YEARS AGO

DM+,HTN+

Investigation

RFT 03-01-2024 03:57:PMUREA252 mg/dl42-12 mg/dlCREATININE11.0 mg/dl1.3-0.9 mg/dlURIC ACID9.6 mg/dl7.2-3.5 mg/dlCALCIUM8.1 mg/dl10.2-8.6 mg/dlPHOSPHOROUS7.4 mg/dl4.5-2.5 mg/dlSODIUM140 mEq/L145-136 mEq/LPOTASSIUM4.2 mEq/L5.1-3.5 mEq/LCHLORIDE104 mEq/L98-107 mEq/LHBsAg-RAPID03-01-2024 03:57:PMNegative Anti HCV Antibodies - RAPID03- 01-2024 03:57:PMNon Reactive COMPLETE URINE EXAMINATION (CUE) 03-01-2024 03:57:PMCOLOURPale yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMIN+SUGARNilBILE SALTSNilBILE PIGMENTSNilPUS CELLS2-4EPITHELIAL CELLS2-3RED BLOOD CELLSNilCRYSTALSNilCASTSNilAMORPHOUS DEPOSITSAbsentOTHERSNilRFT 04-01-2024 11:42:PMUREA258 mg/dl42-12 mg/dlCREATININE11.3 mg/dl1.3-0.9 mg/dlURIC ACID8.9 mg/dl7.2- 3.5 mg/dlCALCIUM7.0 mg/dl10.2-8.6 mg/dlPHOSPHOROUS8.9 mg/dl4.5-2.5 mg/dlSODIUM139 mEq/L145-136 mEq/LPOTASSIUM3.9 mEq/L5.1-3.5 mEq/LCHLORIDE106 mEq/L98-107 mEq/LLIVER FUNCTION TEST (LFT) 05-01-2024 10:58:AMTotal Bilurubin0.68 mg/dl1-0 mg/dlDirect Bilurubin0.19 mg/dl0.2-0.0 mg/dlSGOT(AST)17 IU/L35-0 IU/LSGPT(ALT)21 IU/L45-0 IU/LALKALINE PHOSPHATE274 IU/L119-56 IU/LTOTAL PROTEINS7.0 gm/dl8.3-6.4 gm/dlALBUMIN4.23 gm/dl4.6- 3.2 gm/dlA/G RATIO1.53ABG 05-01-2024 02:38:PMPH7.25PCO223.3PO2114HCO310.0St.HCO312.6BEB-15.5BEecf-15.8TCO221.5O2 Sat97.3O2 Count13.9COMPLETE URINE EXAMINATION (CUE) 05-01-2024 03:27:PMCOLOURPale yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMINNilSUGARNilBILE SALTSNilBILE PIGMENTSNilPUS CELLS2-3EPITHELIAL CELLS2-3RED BLOOD CELLSNilCRYSTALSNilCASTSNilAMORPHOUS DEPOSITSAbsentOTHERSNilABG 05-01-2024 05:54:PMPH7.49PCO220.1PO2115HCO315.4St.HCO319.1BEB-6.5BEecf-7.4TCO231.8O2 Sat96.0O2 Count12.4RFT 05-01-2024 11:30:PMUREA122 mg/dl42-12 mg/dlCREATININE6.7 mg/dl1.3-0.9 mg/dlURIC ACID4.8 mg/dl7.2-3.5 mg/dlCALCIUM8.9 mg/dl10.2-8.6 mg/dlPHOSPHOROUS5.5 mg/dl4.5-2.5 mg/dlSODIUM139 mEq/L145-136 mEq/LPOTASSIUM3.2 mEq/L5.1-3.5 mEq/LCHLORIDE102 mEq/L98-107 mEq/LRFT 06-01-2024 11:01:PMUREA78 mg/dl42-12 mg/dlCREATININE4.8 mg/dl1.3-0.9 mg/dlURIC ACID3.0 mg/dL

l7.2-3.5 mg/dlCALCIUM9.1 mg/dl10.2-8.6 mg/dlPHOSPHOROUS4.0 mg/dl4.5-2.5 mg/dlSODIUM140 mEq/L145-136 mEq/LPOTASSIUM3.1 mEq/L5.1-3.5 mEq/LCHLORIDE98 mEq/L98-107 mEq/LPOST LUNCH BLOOD SUGAR07-01-2024 04:14:PM132 mg/dl140-0 mg/dlRFT 07-01-2024 10:38:PMUREA124 mg/dl42-12 mg/dlCREATININE7.1 mg/dl1.3-0.9 mg/dlURIC ACID4.9 mg/dl7.2- 3.5 mg/dlCALCIUM9.7 mg/dl10.2-8.6 mg/dlPHOSPHOROUS5.4 mg/dl4.5-2.5 mg/dlSODIUM140 mEq/L145-136 mEq/LPOTASSIUM3.4 mEq/L5.1-3.5 mEq/LCHLORIDE101 mEq/L98-107 mEq/LRFT 09-01-2024 02:48:PMUREA81 mg/dl42-12 mg/dlCREATININE3.9 mg/dl1.3-0.9 mg/dlURIC ACID4.3 mg/dl7.2-3.5 mg/dlCALCIUM9.9 mg/dl10.2-8.6 mg/dlPHOSPHOROUS5.1 mg/dl4.5-2.5 mg/dlSODIUM135 mEq/L145-136 mEq/LPOTASSIUM3.5 mEq/L5.1-3.5 mEq/LCHLORIDE101 mEq/L98-107 mEq/LRFT 09-01-2024 10:47:PMUREA62 mg/dl42-12 mg/dlCREATININE4.4 mg/dl1.3- 0.9 mg/dlURIC ACID2.7 mg/dl7.2-3.5 mg/dlCALCIUM9.4 mg/dl10.2-8.6 mg/dlPHOSPHOROUS4.4 mg/dl4.5-2.5 mg/dlSODIUM136 mEq/L145-136 mEq/LPOTASSIUM3.1 mEq/L5.1-3.5 mEq/LCHLORIDE102 mEq/L98-107 mEq/LCOMPLETE URINE EXAMINATION (CUE) 10-01-2024 12:19:PMCOLOURPale yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMIN++SUGARNilBILE SALTSNilBILE PIGMENTSNilPUS CELLS3-4EPITHELIAL CELLS2-4RED BLOOD CELLSNilCRYSTALSNilCASTSNilAMORPHOUS DEPOSITSAbsentOTHERSNilSTOOL FOR OCCULT BLOOD10-01-2024 12:19:PMNegative (-ve)RFT 11-01-2024 07:44:AMUREA70 mg/dl42-12 mg/dlCREATININE4.6 mg/dl1.3-0.9 mg/dlURIC ACID4.4 mg/dl7.2-3.5 mg/dlCALCIUM9.7 mg/dl10.2- 8.6 mg/dlPHOSPHOROUS2.2 mg/dl4.5-2.5 mg/dlSODIUM138 mEq/L145-136 mEq/LPOTASSIUM3.2 mEq/L5.1-3.5 mEq/LCHLORIDE100 mEq/L98-107 mEq/L

USG

IMPRESSION:

MULTIPLE CYSTS IN B/L LIDNEYS ALMOST COMPLETELY REPLACING RENAL PARENCHYMA

B/L POLYCYSTIC KIDNEY

2D ECHO:

RWMA + ANT WAL HYPOKINESIA

EF 52%

FAIR LV FUNCTION

DIASTOLIC DYSFUNCTION+

MINIMAL PE+

DILATED LA

MILD DIALATED LV

Treatment Given(Enter only Generic Name)

FLUID RESTRICTION <1.5L/DAY

SALT RESTRICTION<2G/DAY

TAB NODOSIS 1000MG PO TID

TAB SHELCAL CT PO OD

TAB OROFER XT PO OD

TAB NICARDIA 20MG PO TID

INJ IRON SUCROSE 100MG IV BD

INJ EPO 1000 IV SC STAT

SYP GRILLINTUS 15ML PO TID

NASIRION NASAL DROPS

TAB ATXIM 200MG PO BD

TAB MONTEX PO BD

Advice at Discharge

FLUID RESTRICTION <1.5L/DAY

SALT RESTRICTION<2G/DAY

TAB NODOSIS 1000MG PO TID

TAB SHELCAL CT PO OD

TAB OROFER XT PO OD

TAB NICARDIA 20MG PO TID

INJ IRON SUCROSE 100MG IV BD

INJ EPO 1000 IV SC STAT

SYP GRILLINTUS 15ML PO TID

NASIRION NASAL DROPS

TAB ATXIM 200MG PO BD

TAB MONTEX PO BD

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