A 45 year old female patient came with chief complaints of fever and vomitings since 10 days

 A 45 year old female patient Homemaker by occupation came with chief complaints of fever and vomitings, decreased urinary output since 10 days 

HOPI 

Patient was apparently asymptomatic 1 yr back. Then she developed vomiting, pedal edema and decrease urine output since 1 week .They went to the hospital and was diagnosed with kidney disease and she had 2 dialysis sessions .

Now again after 1yr from 10 days she developed vomiting and fever and decreased urinary output.

Vomiting was non projectile and non blood tinged .Fever was associated with chills and rigor and increased during night time.

Patients daily routine

Patient is a homemaker and daily gets up in the morning and does house hold work.Before 4 yrs she worked as a agricultural labourer 

 past history

No history of DM,HTN, thyroid disorders, Tuberculosis,Asthma 

Family history No significant family history 

Personal history

Diet:mixed 

Appetite: Decreased

Bowel and bladder : Regular

Addictions:No addictions 

General examination

Patient was conscious coherent and cooperative

Moderately built and nourished

Pallor: present

Icterus: absent 

Cyanosis: absent

Clubbing: absent

Generalized lymphadenopathy:absent 

Edema : absent

Vitals 

Temperature Afebrile

Pulse rate 75 bpm

Respiratory rate 14 cpm 

BP 130/90 

Systemic examination 

Respiratory system BAE present normal vesicular breath sounds present

CVS s1 s2 heard no murmurs

GIT soft and non tender 

CNS no focal neurological deficit 

Investigations









Provisional diagnosis
B/L groin hydroureteronephrosis
B/L ureteric calculi 
Post ride sided DJ stenting

Treatment

Inj.piptaz 2.25mg iv TID
Inj.metrogyl 500 mg iv BD
 Tab.Nodosis 500 mg po BD
T.Shelcal po OD








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