Chronic kidney failure - Analgesic Nephropathy

 This is an online E-log book to discuss our patient's identified health data shared after taking his/ her guardians signed informed consent.

 

Here we discuss our individual patient problems through a series of inputs from available Global online community of experts with an aim to solve the patients  clinical problem with current best evidence based input.

 

This E-log also reflects my patient centered online learning portfolio.

I have 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 a diagnosis and treatment plan.


CASE SCENARIO:

A 50 year old male presented to the OPD with nausea, Facial puffiness, reduced urine output and Pedal edema 






COMPLAINTS AND DURATION

  • Weight loss  

  • Pedal edema
  • Decreased urine output

  • Shortness of breath on exertion

  • Facial edema

  • Decreased appetite  



















HISTORY OF PRESENT ILLNESS

Patient apparently asymptomatic 2 years ago , developed chronic leg pain due to occupation as a toddy farmer. He took some painkillers for the pain. 6 months ago in the month of may he had generalised swelling and complained of shortness of breath. On admitting to a hospital in Hyderabad they noticed that the serum creatinine was elevated and was prescribed diuretics and was recommended to stop alcohol and the pain medication. He remained asymptomatic till 2 weeks ago where he drank alcohol and missed on his medicines during the festival season.


HISTORY OF PAST ILLNESS

  • Not a K/C/O HTN, DM

  • Reduced Hemoglobin and elevated serum creatinine 


TREATMENT HISTORY

Unknown over the counter painkiller for 1 year

Diuretics since 4 months


PERSONAL HISTORY

  • Single

  • Appetite - lost

  • Bowels- regular

  • Micturition - reduced

  • Alcohol minimum 180 ml a day till one year ago, now only occasionally


FAMILY HISTORY

  • No significant family history


MENSTRUAL HISTORY

  • Age of menarche - 14 years 

  • Menstrual cycle = 28 days/ 3 days. Oligomenorrhea since 6 months.


PHYSICAL EXAMINATION

  1. GENERAL

  • Pallor - Yes

  • Icterus - No 

  • Cyanosis - No

  • Clubbing of finger/toes - No

  • Lymphadenopathy - No

  • Oedema - yes 

  • Malnutrition - No 

  • Dehydration - No 

  • Temperature - afebrile 

  • Pulse rate 92 b/min
  • Respiration rate - 20/min
  • RBS - 92 mg/dl
  • BP 140/90 mmHg 
















SYSTEMIC EXAMINATION 

  1. CARDIOVASCULAR SYSTEM

  • Thrills - No 

  • Cardiac sounds - S1 , S2 positive


  1. RESPIRATORY SYSTEM 

  • Dysponea - No 

  • Wheeze - No

  • Position of trachea - Central 

  • Breath sounds - Vesicular 

  • Adventitious - Rhonchi 


  1. ABDOMEN

  • Shape of abdomen - Scaphoid


  1. CENTRAL NERVOUS SYSTEM 

  • Level of consciousness 

  1. Alert

  2. Stuporous 

  • Signs of meningeal irritation

  1. Neck stiffness - no

  2. Kerning’s sign - no

  • Cranial nerves - normal 

  • Motor system - normal

  • Sensory system - normal 

  • Glasgow system - normal 

  • Cerebral signs

  1. Finger nose coordination - Yes

  2. Knee Heel In-coordination - Yes


F.MUSCULO SKELETAL SYSTEM - normal 


G. SKIN - normal

 

H. EXAMINATION OF BREAST - normal


I. EXAMINATION OF ENT - normal


J.EXAMINATION OF TEETH AND ORAL CAVITY - normal


K. EXAMINATION OF HEAD AND NECK  - normal


PROVISIONAL DIAGNOSIS/ DIAGNOSIS 

  1. Chronic renal failure due to analgesic Nephropathy
  2. DM since admission
  3. HTN since 6 months undiagnosed till admission
  4. Moderate anaemia




TREATMENT
  • Patient on dialysis
  • Nifedipine for High blood pressure
  • Lasix diuretic
  • Erythropoietin and iron supplement for anaemia
  • IO control and charting




Thanks to Rakesh Biswas, HOD of General medicine, PGs and Interns for helping me with this case.








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