case 38

61year old male 
DOA -03/01/2024
DOD -12/01/2024
CKD DURATION - 6years and is on maintenance hemodialysis since 6months.


DIAGNOSIS 

POLYCYSTIC KIDNEY DISEASE STAGE V CHRONIC KIDNEY DISEASE ANEMIA SECONDARY TO CKD 
DM+
HTN+

Case History and Clinical Findings

C/O SOB SINCE 1WEEK
 DECREASED URINARY OUTPUT SINCE 4DAYS

HOPI:PATIENT WAS APPARENTLY ASYMPTOMATIC 1WEEK BACK ASYMPTOMATIC THEN DEVELOPED SOB 
INSIDIOUS GRADUALLY PROGRESSIVE 
GRADE 2 -3 NO ORTHOPNEA PND +
H/O DECREASED URINE OUTPUT SINCE 4DAYS
NO H/0 FEVER NO BURNING MICTURITION.
K/C/O AD PCKD

PAST HISTORY -
DM SINCE 4YEARS ON GLICAZIDE 80MG 
HTN SINCE 2 YEARS
 GENERAL EXAMINATION: 
PT IS C/C/C 
BP-140/80 
PR-86BPM
 SPO-99
SYSTEMIC EXAMINATION 
CVS-S1S2+ 
RS-NVBS 
CNS-NFND
P/A-SOFT NON TENDER 

Investigation

HB -9.4
MCV -80
MCH -28
MCHC -31.8
TLC -12500
PLT -1.92

s.iron -32
S.ferritin -380

SMEAR -NORMOCYTIC NORMOCHROMIC 

CUE -

ALBUMIN+
SUGAR -Nil

RFT
UREA258 mg/dl
CREATININE11.3 mg/dl
URIC ACID8.9 mg/dl
CALCIUM7.0 mg/dL
 mg/dlPHOSPHOROUS8.9 mg/dl
SODIUM139
POTASSIUM3.9 
CHLORIDE106

LFT 
Total Bilurubin0.68 mg/dl
DirectBilurubin0.19 mg/dl mg/dl
SGOT(AST)17 
SGPT(ALT)21 
ALKALINE PHOSPHATE274 IU/ 
TOTAL PROTEINS7.0 
ALBUMIN4.0 

USG
IMPRESSION:
MULTIPLE CYSTS IN B/L LIDNEYS ALMOST COMPLETELY REPLACING RENAL PARENCHYMA
B/L POLYCYSTIC KIDNEY

2D ECHO:
MODERATE AR, MILD MR, MILD TR WITH PAH
RWMA + ANT WAL HYPOKINESIA
EF 52%
FAIR LV FUNCTION
DIASTOLIC DYSFUNCTION+
MINIMAL PE+
DILATED LA
MILD DIALATED LV

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/2WEEKS
PRBC TRANSFUSED -0
ADMISSION IN ICU -0


Treatment Given(Enter only Generic Name)
FLUID RESTRICTION <1.5L/DAY
SALT RESTRICTION<2G/DAY
TAB ARKAMINE 0.1 MG PO TID 
TAB. ECOSPRIN GOLD PO / HS 
TAB LASIX 80 MG PO BD
 TAB SHELCAL CT PO OD 
TAB OROFER XT PO OD
 TAB TELMA 40 MG PO OD
 TAB NICARDIA 20MG PO TID
 INJ IRON SUCROSE 100MG IV BD 
INJ EPO 1000 IV SC WEEKLY once
 
Advice at Discharge

FLUID RESTRICTION <1.5L/DAY 
SALT RESTRICTION<2G/DAY
 TAB ARKAMINE 0.1 MG PO TID
 TAB. ECOSPRIN GOLD PO / HS
 TAB LASIX 80 MG PO BD
 TAB SHELCAL CT PO OD 
TAB OROFER XT PO OD
 TAB TELMA 40 MG PO OD 
TAB NICARDIA 20MG PO TID
 INJ IRON SUCROSE 100MG IV BD
 INJ EPO 1000 IV WEEKLY once 

Follow up at the 3months 
HB -10.8
MCV -84.7
MCH -29.4
MCHC -30.1
TLC -7400
PLT -2.43

Follow up at the end of thesis 
HB -10.4
MCV -84.2
MCH -29.3
MCHC -30.1
TLC -8200
PLT -2.76

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