A 29 year male with chronic kidney disease secondary to NSAID abuse
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I’ve been given this case to solve in an attempt to understand the topic of “patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations, and come up with diagnosis and treatment plan
A 29 year male agricultural coordinator by occupation came to opd with chief complaints of
Bilateral pain in lower limbs upto knee since 20 days
HOPI
Patient was apparently asymptomatic 3 years ago then developed severe sudden pain in right lower abdomen for which he went to local hospital and was diagnosed to have renal calculus of 4 - 6 mm & creatinine levels of 6.2 and got treated for it. Both the parameters came down when he got tested later after few weeks.
6 months later patient developed pain in ankle and knees bilaterally, pricking type precipitated by heavy work, relieved by medications for which he visited a local doctor and was tested with high uric acid levels for which he got treated and also got dietary change advice
followed by this he was intermittently having lower limb pain for which he was having acyclophenac whenever he was having episodes of pain
Since 20 days pain wasn't reliving on medication and he got admitted to a local hospital. his creatinine levels were 8.2 for which he was referred to our hospital for dialysis
No h/o shortness of breath , pedal edema , decreased urine out put , facial puffiness, orthopnea, pnd , chest pain and palpitation
Past history
Right sided renal stone of size 4 - 6 mm for which he got treated medically - 3 years ago
Rat poisoning 6 years ago
Not a known case of diabetes , hypertension ,asthma ,tb, cardiovascular diseases.
Personal history
Diet : mixed
Appetite normal
Sleep : inadequate due to pain since 20days
Bowel and bladder movements regular
No allergies
Occasional alcohol consumption
Chronic smoker since 6 years ( stopped 8 months back)
Treatment history
H/o usage of NSAIDs for pain since 2 yrs intermittently
Family history
Not significant
General examination
Patient was conscious coherent and cooperative
pallor present
No icterus cyanosis clubbing lymadenopathy,edema
Vitals
BP -140/80
RR - 14/min
Temp - 98F
Pulse rate - 78bpm
Spo2 98percent
Grbs - 134 mg%
Systemic examination:
CVS - s1s2 heard no murmurs
Respiratory system
Dyspnoea: No
Wheeze: No
Position of trachea: Central
Breath sounds: Vesicular
Adventitious sounds : No
Per abdominal examination
Shape - Scaphoid , inverted umbilicus, no engorged veins, no scars
No tenderness, no palpable mass, No Fluid
No bruits heard
Liver not palpable
Spleen not palpable
CNS Examination
Conscious coherent cooperative
Higher mental functions intact
No signs of meningitis
Cranial nerves, motor system, sensory system Normal.
INVESTIGATION
HIV - non reactive
HBsAg - negative
RBS - 114 mg/dl
Blood urea - 176 mg/dl
Serum creatinine - 7.8mg/dl
PROVISIONAL DIAGNOSIS
CHRONIC KIDNEY DISEASE secondary to NSAID abuse
TREATMENT
1) salt restriction <2 g /day
2) fluid restriction <1.5L /day
3) T.NODOSIS 500mg PO/BD
4) T.OROFER-XT PO/OD
5) T.SHELCAL - CT PO/OD
6) T.CAP BIO D3 60,000IU units per weekly
7) T.LASIX 10 mg PO/BD
7) moniter vitals 4 th hrly
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