AKI on CKD 2° to HTN

May 18, 2022

AKI on CKD 2° to HTN

Cheif complaints: A 65year old man came to hospital with complaints of fever on and off , tightness of abdomen ,facial puffiness since 15 days

History of present illness:

A 65 year old male toddy tree climber by profession was apparently asymptomatic 10 years back then he was had swelling and pain abdomen for which he was diagnosed with- lt sided inguinal hernia and got operated in some private hospital. Preoperative and postoperative period was uneventful

4 years back patient had complaint of giddiness for which he approached government hospital physician and was diagnosed Hypertension[170/90] and was started on some unknown medication

6 months back patient had complaint of bilateral pedal edema for which investigations were done and found his serum creatinine elevated (4.3 ) and proteins in urine

CT scan showed unilateral (lt)staghorn renal calculi and bilateral inguinoscrotal hernia

DTPA scan was done showing decreased GFR on left side( 12%) and right (88%)

For these he was started on supportive medications like ( cinidipine t, dytor and some multivitamins) and was on regular medication

From past 15 days patient developed fever on and off , low grade which is subsiding on dolo once daily ,(sometimes tepid sponging), evening rise of temp present , not associated with chills and rigors ,not associated with pain abdomen , nausea, vomiting, loose stools ,burning micturition, cough ,night sweats.

From past 5 days patient also had decreased appetite and tightness in abdomen,facial puffiness, shortness of breath and pedal oedema for which he was investigated

Patient is not a k/c/o dm,tb,epilepsy,thyroid abnormality.

Patient is alcoholic (occasional drinker 1 quarter a month) stopped from past 6 months

On Examination :

Patient is conscious ,coherent ,cooperative

Oriented to time place and person

No signs of pallor, icterus, cyanosis, clubbing ,lymphadenopathy

Edema + (pitting type grade1)

Local examination:

Git -

Inspection - abdomen distended ,no visible scars or pulsation, no venous engorgement seen skin appears normal

? Scar of prev hernia surg seen at inguinal region

Palpation-