Skip to main content

#SHORT CASE : POST RENAL ACUTE KIDNEY INJURY D/T PROSTATOMEGALY AND RT SIDED PLEURAL EFFUSION


1801006199 - SHORT CASE

on 

 This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs". This E log book also reflects my patient-centered online learning portfolio and your valuable comments in comment box is welcome

Case report 

70 yr old male farmer has presented to the OPD with c/o decreased urine output since 19 days 

HOPI

Patient was apparently asymptomatic 19 days ago then he noticed that his urine output has been decreasing. It is associated with burning micturition. No H/o Pyuria, dysuria ,pain abdomen, loin pain. 

Reddish discolouration of Urine present 4days back

He also Complains of an Episode of Non bilious vomiting 4days back

The patient also reports that 6 days ago he had an episode of dizziness for which he went to a local hospital where he was diagnosed as BPPV and was managed conservatively.

Past History 

The patient gives History of Haemodialysis About 10 yrs ago after He had fever with abdominal distension 

He is a K/c/O CVA 15 yrs ago 

K/c/o HTN Since 10 yrs initially on T. LOSAR H AND PRESENTLY ON T.TELMA H PO OD 

Not a K/c/o DM , Asthma, TB, Epilepsy, CAD , Thyroid disorders 

Personal History 

Appetite :- Normal

Diet ,:Mixed

Bowel : regular 

Sleep :- Adequate 

Addictions :- 

 Regular Alcoholic stopped 12 yrs ago 

Regular smoker - Used to smoke 2-3 beedis per day 

Stopped 12 yrs ago 


General Examination

Patient is C/c/C 

No pallor, icterus, cyanosis, Lymphadenopathy, Pedal edema 

Temp :- 98.5F

Bp :- 170/110mmHg 

PR:- 92 bpm

Spo2 :- 99 % @RA 




Systemic examination:

CVS :- S1s2+ No murmurs 

RS :- BAE+ NVBS + 

PA:- Soft NT 

CNS :- NFND 

Investigations:

Haemogram: hb: 9.4mg/dl

lymphopenia, PCV decreased, mch, mcv, RBC count decreased

Blood urea: 55mg/dl (normal= 17-50mg/dl)

Serum Creatinine: 1.8 mg/dl (normal = 0.8-1.3mg/dl)

Serum electrolytes: 

 Sodium: 122mg/dl (normal = 136-145mEq/l

 chloride: 90mg/dl (normal = 98-107mEq/l

Spot urine sample:

 Urine protein: 8mg/dl

 Urine creatinine: 15mg/dl

 Ratio : 0.53

ECG:


Chest X-ray PA view:


USG abdomen and pelvis:

Grade 3 prostatomegaly

Rt kidney grade 2 rpd changes

Lt kidney grade 1 rpd changes

Moderate rt side pleural effusion and collapse of rt lower lobe

USG Chest:

 Lt lung normal

 Rt lung shows moderate pleural effusion with air bronchogram and collapse of lower zones


Diagnosis: Post renal Acute kidney injury due to protatomegaly and rt sided pleural effusion


Pleural fluid examination:

Under aseptic conditions under USG guidance and 2% lignocaine instilled and 20cc syringe placed in 6th intercostal space in rt interscapular area and 20ml straw colored fluid is aspirated 


 Pleural fluid LDH: 486IU/L (normal:230-460IU/L)

Pleural sugar: 80mg/dl (normal: 60-90mg/dl)

Pleural protein: 4g/dl (normal: 0-2.5mg/dl)

pleural fluid cytology:

cytosmear shows predominantly lymphocytes and no malignant cells

Comments

Post a Comment

Popular posts from this blog

9M LEFT GROSS HYDRONEPHROSIS

Image
 A 9 years old male who is a school going student came with C/O     left loin pain since 2 months, intermittent episodes of pain abdomen (about 2-3days of pain per week). C/o decreased urine output, with dribbling of urine, thin & poor stream, with post void residue + (not relieved completely). C/o fever, moderate grade, intermittent, about 1 ep in a week.  H/o nausea +,  Decreased appetite+. Patient was apparently asymptomatic 6 years, 3 months back then the patient's attender's started noticing increased abdominal girth and distended abdomen when the patient was just 3 years old i.e, approximately around jan/Feb/March - 2018. The child was born on 25/02/2005. He appeared healthy at birth. APRIL, 2019. In 2019, child had episodes of pain abdomen for which he was advised USG abdomen - incidentally it was found that the child had solitary kidney. In 2019, he was taken to Urologist in West Bengal, who apparently informed the attenders about the child's condition (and alle
Read more

65 Y OLD WITH HEMIPLEGIA

Image
This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input. This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. 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 diagnosis and treatment plan. Patient and his/her attenders have been informed and their consent has been taken. 65 yr old female was brought to the casualty with complaints of Difficulty in moving upper limbs and lower limbs since 3 days
Read more

40M TYPE 1 DIABETES MELLITUS WITH UNCONTROLLED SUGARS, ATROPHIED PANCREAS

Image
 A 40 years old male, an auto driver by occupation came to OPD with C/O   loss of consciousness at around 3 am since 20 days C/O nausea since 1 week C/O weakness since 1 week HOPI  :  Patient was apparently asymptomatic 20 days ago then developed hypoglycemic symptoms at around 3 am and patient became unresponsive. Hypoglycemic symptoms were relieved on having some sugar syrup or chocolate. Similar episode has been occurring on a daily basis from the past 1 week. H/O of increased physical activity beyond patient's usual routine from past 20 days                                     ⬇️    H/O of which hypoglycemic event occurred early in morning  No h/o sweating, palpitations during that episode.  No h/o vomiting, blurring of vision during that episode  No h/o of fever No h/o pain abdomen, loose stools  No h/o burning micturition, decreased urine output  No h/o polyurea , polydypsia , polyphagia  No h/o similar complaints in day time  Year -2001   23 years ago, he experienced head tr
Read more