80M with CKD and HTN
Vijaya
80M AKI 1M HTN 10YRS DM
August 18, 2023
PRESENT HISTORY
An 80-year-old male resident of Kamanpet was admitted with complaints of acute urinary and fecal retention for the past 24 hours. The patient had been in a stable condition until a month ago when he began experiencing bilateral lower limb and knee pain. He sought care at a local hospital and received conservative management. During this time, he was informed about the risk of kidney injury and advised to follow a renal diet.
Yesterday, the patient experienced an inability to defecate (accompanied by the absence of flatus) and urinate, along with shortness of breath. There is no history of fever, but the patient did report constipation two days ago.
PAST HISTORY
known case of hypertension for the past 10 Years and has been diagnosed with diabetes mellitus for the past 6 years.
GENERAL EXAMINATION
No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema
BP-110/70mmhg
PR - 70bpm
GRBS
Spo2-98% at RA
CVS- s1s2 heard, no murmur
R/S- BAE present, NVBS
P/A- Soft,NT
CNS- NFND
P/R : No anal tags, Anal fissure noted in 6’o clock posistion and No fistula
Anal tone decreased
Glove stained with stool
CLINICAL IMAGES
PROVISIONAL DIAGNOSIS
AKI WITH ?DIABETIC NEPHROPATHY
TYPE 2DM and HTN
INVESTIGATIONS
HB - 10.7gm/dl. —> 12gm/dl
TLC- 12,200 cells/cumm. —> 11,100
PLATELETS- 2.75lakhs/cumm. —> 2.8
CUE
COLOUR- pale yellow
Appearance- clear
Reaction- acidic
SP gravity- 1.010
ALBUMIN- +
SUGAR- ++
BILE SALTS- NIL
BILE PUGMENTS- NIL
PUS CELLS - 2-4
EPITHELIAL CELLS- 2-3
RBC - NIL
CRYSTALS- NIL
CASTS- NIL
AMORPHOUS DEPOSITS - NIL
FBS-107
PLBS-197
HBA1C-6.7
Serum osmalality - 247 mOSM/kg
URINARY ELECTROLYTES
SODIUM - 108
POTASSIUM-9.73
CHLORIDE-153
SPOT UPCR
URINE PROTEIN - 13.6
CREATININE-28.0
RATIO- 0.48
RFT
UREA - 66mg/dl. 58mg/dl. 54mg/dl
CREATININE- 2.78mg/dl. 2.2mg/dl. 2.7mg/dl
URIC ACID-6.1mg/dl. 5.3mg/dl. 5.2mg/dl
CALCIUM- 9.4mg/dl. 10mg/dl. 9.9mg/dl
SODIUM- 128meq/L. 126mEq/L. 133mEq/L
POTASSIUM - 4.4 mEq/L. 4.3mEq/L. 5.0mEq/L
CHLORIDE- 92mEq/L. 93mEq/L. 91mEq/L
ABG
PH -7.4
Pco2- 26.8
Po2- 103
Hco3-16.7
Interpretation: primary respiratory alkalosis acute with secondary metabolic acidosis
ECG
CHEST X-RAY
ERECT ABDOMEN X RAY
USG ABDOMEN
Right Renal calculi e/o 6mm in the mid pole of right kidney
Right Hydrouretronephrosis
Left complex Renal cortical cysts
Grade 1 RPD changes in bilateral kidneys
2D ECHO
EF 64%
IVC Size (1.09cms) collapsing
Moderate to severe MR (eccentric MR) Mild AR/TR with PAH
No RWMA
No AS/MS, sclerotic AV
Good LV systolic function
No diastolic dysfunction, No PE
REVIEW 2D ECHO ON 23-08-2023
No RWMA
IVC 1.45cms Non collapsing
RVSP= 42+10=52mmhg
PML PROLAPSE
Moderate to severe MR (eccentric MR) moderate AR mild to moderate TR with PAH
No AS/MS, sclerotic AV
Good LV systolic function
diastolic dysfunction present,No PE
UROLOGY REFERAL
Surgery Referal
