Nephro case-

A 58yr old male presented to casualty complaining of Shortness of breath grade 4 since 4-5 days worsening since 2 hours 

Decreased urine output since 4-5 days 

Pedal oedema on and off since 6 months 

Now subsided ( outside medications ) 

He was apparently alright 8 years back developed pedal oedema and shortness of breath and was taken local hospital and was diagnosed to be diabetic and hypertensive and chronic kidney disease with baseline creatinine of 2.5mg/dl 

He had recurrent episodes of sob and was admitted 1/2 times and was managed symptomatically 

Since 10-12 days he developed fevers of high grade intermittent type not associated with chills, a/w cough with expectoration, scanty ( occasionally) 

Decreased urine output since 4-5 days, no history of lower urinary tract symptoms ( urgency, hesitation, frequency, post voi dal residue ) 

And was also diagnosed with peri anal abscess/pilonidal sinus and was referred to our hospital for further management 

On admission 

Patient conscious 

BP - 130/90 

PR - 112 

Spo2 95% on RA 

CVS : S1,S2 present 

RS : BAE + 

B/l Expiratory wheeze in infraclavicular are 

Inspiratory crepts in IAA right side 

P/A : soft non tender 

BS+ 

CNS : No FND 

ABG 

PH 7.2

Pco2 : 12.1 

Po2 : 111 

Hco3: 5.1 ( gave correction 

50meq stat 

100meq through 100ml NS ) 

USG ABDOMEN: 

Kidney size

Right : 8.2 X 3.5

Left : 7.5 X 3.2

Grade 4 RPD 

RFT 

Urea : 311

Creatinine : 7.1 

Sodium : 132

Potassium : 6.0 ( gave correction ) 

Cloride : 104 

Hemogram 

Hb : 4.5gm%

TLC : 22,750

Plt : 3L/mm3

Plan : Hemodialysis