57 YEAR OLD MALE WITH PAIN IN RIGHT LOIN AND FFROATHY URINE

Name:ARUSHI 
Internship 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. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome. 

A 57 year old male resident of narketpally came to the OPD with chief complaints of pain in the right loin , froathy urine ,fever and decreased appetite since 10 days.


HOPI:
Patient was apparently asymptomatic 10 days back then he had pain in the right loin region which is insidious in onset and gradually progressive not associated with nausea, vomiting and loose stools.
H/o froathy urine, fever with chills and rigor and decreased appetite since 5 days.
Altered sensorium since 4 days.
No H/o cold cough.


Past history : He is a known case of renal failure since 1 year.
- H/o NSAID abuse.
No history of allergies , asthma, epilepsy, TB, any thyroid disorders, HTN, DM .

Family History: Not significant

Treatment History: H/o NSAID use. 

Personal history : 
 
Diet ‐ mixed.
Appetite ‐ decreased.
Sleep ‐ inadequate.Sleep is interrupted by abdominal pain.
Bowel and Bladder movements ‐ irregular.
Micturition : abnormal.
Addictions: None.

General Examination:
 Patient is conscious, coherent, cooperative, moderately built and nourished.
- No pallor, Icterus, cyanosis, clubbing, generalised lymphadenopathy . 
- Pedal edema is present. 

VITALS : 
Temperature ‐Afebrile.
Pulse rate ‐ 118 bpm
BP ‐ 110/80 mmHg
RR 30 cpm
SpO2 :98%
GRBS 116 gm/dl.


Systemic Examination :
RS: BAE+, clear ,No wheeze,dyspnoea.
CVS: S1 S2 + , NO added sounds or murmers.
P/A: soft and tender ,No organomegaly.
CNS : No focal Neurolical deficit.

Invesigaions
Provisional diagnosis:
AKI on CKD secondary to NSAID Abuse and anaemia secondary to renal failure.

Treatment:

1.Fluid and salt restrictions.
2.Inj LASIX 40mg IV BD
3.INJ PANTOP 40 mg IV BD.
4.INJ TRAMADOL 1 amp in100ml NS BD.
5.inj NEOMOL 1g  IV 80s
6.Tan PCM 500 mg po TID.
7.Tab NODOSIS 500 Mg po TID.
8.Tab SHEZCAL 500 mg po TID.
9.Cap BIO D3D3 po weekly once.
10. Monitor vitals 4 hourly.

My orientation around this case :
1. What is the mechanism of development of AKI in patient with NSAID abuse? 
Ans. Reduced renal blood flow due to decreased Prostagandin synthesis which regulate vasodilatation at the glomerular level. 
2. 






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