General medicine monthly online assessment


    A CASE OF ANALGESIC NEPHROPATHY

This Eblog has been created under the guidance of  Dr MADHUMITHA BUDIGAM

The case is :
A 72 year old male patient who is a farmer came to OPD. His 
CHIEF COMPLAINTS are :-
On CKD He has Analgesic nephropathy
He has k/c/o hypertension (HTN) since 4 years and he underwent 4 sessions of HD(hemodialysis). 
 He had h/O consuming NSAID 7yrs back intermittently . 
  
HOPI:-Patient was apparently asymptomatic 7 yrs ago. He gives history of consuming NSAIDs since 7 yrs intermittently because of which he developed chronic kidney disease for which he was on conservative management.  He is a k/c/o hypertension since 4 years. He came  on 19.6.2021 for AKI (secondary to GN) on CKD  ( analgesic nephropathy). He underwent 4 sessions of hemodialysis.

PERSONAL HISTORY:-
Normal appetite
Non vegetarian
Regular Bowels 
Normal micturition
No allergies
No addictions
 
TREATMENT HISTORY:-
No diabetes
HYPERTENSION since 4 years 
No CAD
No Asthma
No tuberculosis
No antibiotics
No hormones
No radiation /chemo
No blood transfusion
No surgeries 
No other 

GENERAL EXAMINATION:-

The patient is consious
                         Coherent
                         Cooperative

PALLOR is present
No icterus 
No clubbing
No cyanosis
No oedema
No lymphadenopathy
No malnutrition
Mild dehydration is seen 


SYSTEMIC EXAMINATION:-
 
VITALS:  PR=83bpm
                Bp=120/60mmHg
                Temp=afebrile

CVS      :-S1, S2 are heard 
               No thrills
               No cardiac murmurs
               No focal deficits 

RESPIRATORY SYSTEM:- BAE+
                                             NVBS 
                                             No cripts
PER ABDOMEN:-
shape of abdomen is Scaphoid
Tenderness is not seen 
No palpable mass 
Bowel sounds are heard 
Liver and spleen are not palpable
No free fluid
No bruits
Normal hernial orifices 

CNS:-       
Patient is conscious. 
Speech is normal.
No signs of meningeal irritation. 
Reflexes are normal


PROVISIONAL DIAGNOSIS:-
CKD 2° to Analgesic Nephropathy on MHD
K/c/o HTN 

INVESTIGATIONS :-

                           serum iron
RFT


CBP


Report

TREATMENT

1. Tab. LASIX          40mg/PO/BD
2. Tab. NICARDIA   20mg/PO/BD
3. Tab. NODOSIS    550mg/PO/BD
4. Tab. OROFER. XT PO/BD
5. Tab. SHELCAR   500mg/PO/BD
6. Inj. ERYTHROPOETIN 4000 W/SC weekly once 
 

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