A CASE OF POLYCYSTIC KIDNEY DISEASE PRESENTED IN SPRING 2022

 

NOTE:

  • The following E-log aims at discussing our patient de-identified health data shared after taking the guardian's signed consent.
  • Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve the patients clinical problem with current best evidence based input.
  • This E-log also reflects my patient's centered online learning portfolio.
  • 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 a diagnosis and providing treatment best to our skills and wisdom.

A 55 years old male granite cutter by occupation presented  in the casualty with chief complaints of swelling of both the feet. 

CHIEF COMPLAINTs
➤Swelling of both the feet for past 6 months 
➤Shortness of breath for past 6 months

HISTORY OF PRESENTING ILLNESS

Patient was apparently asymptomatic 8 months back after which he developed productive cough with yellowish expectorant which was relieved by taking medications from the local pharmacy. Cough was on and off type and  cough was causing the chest pain with tightness of chest. It gets further deteriorate accompanied with breathlessness during granite cutting for which he took medication and got temporary relieved . After few days he got left eye injury leading to complete right eye blindness.
Meanwhile his breathlessness got aggravated which was now  not getting relieved by medication .It was also associated with facial puffiness and pedal edema for which he approached this hospital and diagnosed as CRF for which he underwent dialysis. Now he is again presented with the chief complaints of aggravated  pedal edema, breathlessnes and fever for past 6 days.

HISTORY OF PAST ILLNESS 

➤Not a known case of Diabetes, bronchial asthma, epilepsy, TB

➤Known case of HTN currently on medication.

➤He got his right eye hit by a hard stone due to which he lost his  right eye vision permanently. 

PERSONAL HISTORY
➤Mixed diet 
➤Reduced appetite 
➤Adequate sleep
➤Regular bowel movements 
➤Normal bladder movement

FAMILY HISTORY 

➤No significant family history.

GENERAL EXAMINATION 

➤Pallor : Present









➤Icterus :  Not seen

➤Cyanosis :  Not seen

➤Clubbing :  Not seen

➤Lymphadenopathy :  Not seen

➤Edema :Non pitting type edema present on both the feet.


VITALS

➤Temperature :  Afebrile

➤PR : 92 beats per minute

➤BP : 130/70 mm Hg

➤RR : 24 cycles per minute

➤SpO2 : 96% at room air

➤Blood Sugar (random) : 90mg/dl

SYSTEMIC EXAMINATION 

CARDIOVASCULAR SYSTEM EXAMINATION

➤s1 and s2 heard

➤Thrills absent.,

➤No cardiac   murmurs


RESPIRATORY SYSTEM

➤Normal vesicular breath sounds heard.

➤Bilateral air entry present


ABDOMINAL EXAMINATION

➤ SOFT ,NT

CENTRAL NERVOUS SYSTEM EXAMINATION

➤ Pt. was conscious, coherent and co-operative.  
➤ Speech was normal
➤  No slurred speech. 
➤ No meningeal signs.
➤ No abnormality detected. 

Reflexes: 

➤ Right and left biceps, triceps, ankle and supinator show grade 2 reflex.

Gait: 

➤ Normal.

PROVISIONAL DIAGNOSIS :   Polycystic kidney disease and CRF


  Previous Investigations


1. Colour doppler 2D echo: 



                  Diastolic dysfunction. 
Findings include sclerosed aortic valve,
Dilated left atrium,
Left ventricle- Dilated, concentric, LVH.


2. Complete urine examination: 

NORMAL

3. Ultrasound report: 
   

       
Multiple cysts are found in kidney.





   

    Decreased Hb  

RBC count and elevated RDW CV.



 5. Blood sugar is within normal range. 

6. Renal function tests: 

      
Highly elevated urea and creatinine. 
Calcium levels are decreased 
Phosphorous and sodium levels are increased.

7. Liver function test: 


Elevated Direct bilurubin and alkaline phosphate. 
Decreased protein levels. 



8. ECG 




2D echo of heart 



Cysts of Rt. Kidney 


Cysts of left kidney



DAY 1

INVESTIGATIONS
B/L Polycystic kidneys
Multiple hepatic cysts


 

NORMAL SERUM IRON

NORMAL ELECTROLYTES

 ELEVATED Serum Creatinine 3.1mg/dl

ELEVATED Blood Urea -50mg/dl 

DECREASED Hb 5.8gm/dl
ELEVATED Total count 38,000 cells/cumm




TREATMENT

1) Tab. PAN 40mg OD
2) Tab. NODOSIS 500mg
3) Tab. SHELCAL 550mg 0.1mg PO OD
4) Tab. LASIX 40mg PO OD
5) Tab. ARKAMIN 0.1mg PO OD
6) Tab. OROFER PO OD 

DAY 2

TREATMENT

1) Tab. PAN 40mg OD
2) Tab. NODOSIS 500mg
3) Tab. SHELCAL 550mg 0.1mg PO OD
4) Tab. LASIX 40mg PO OD
5) Tab. ARKAMIN 0.1mg PO OD
6) Tab. OROFER PO OD 

Hemodialysis is done
Blood transfusion

DAY 3

TREATMENT

1) Tab. PAN 40mg OD
2) Tab. NODOSIS 500mg
3) Tab. SHELCAL 550mg 0.1mg PO OD
4) Tab. LASIX 40mg PO OD
5) Tab. ARKAMIN 0.1mg PO OD
6) Tab. OROFER PO OD 










 

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