42 yr M with swelling

A 42 yr old male patient from Huzurnagar autodriver by occupation came with chief complaints of 
swelling at Gluteal region since 25 days and fever since 26 days.
HOPI:
Patient was apparently asymptomatic 8 years back then he had giddiness for which he consulted the local doctor and diagnosed as Hypertension. Since then he is on regular medication for Hypertension. 

2 years back he developed fever and pedal edema.Then he went to local hospital.Then on investigations he came to know that his creatinine levels are increased to 4mg/dl. For which he took medication .Symptoms subsided.

On 14/1/22 He had fever with chills
On 15/1/22 He noticed that he had swelling over inferiomedial part of left Gluteal region and perineal region associated with pain.
On 19/1/22 it was drained by local RMP.On investigations he came to know that his creatinine levels were raised. 
Then on 21/1/22 He came to KIMS for treatment.On investigations his creatinine were raised.

PAST HISTORY:
K/C/O Hypertension since 8 years.On regular medication(tab.telma 40mg)
No history of DM,Asthma,Thyroid disorders.

PERSONAL HISTORY:
Diet         : Mixed
Appetite  : Normal
Bowel and bladder movements: Regular 
Sleep        : Adequate
Addictions:
 Alcohol consumption occasionally since 20 years. 
Stopped smoking 10 years ago.

GENERAL PHYSICAL EXAMINATION:
Patient is conscious,coherent,cooperative. Moderately built and nourished. Well oriented to time, place and person.

Pallor              - No
Icterus             -No
Cyanosis         -No
Clubbing          - No
Lymphadenopathy - No
Edema              - No


Vitals:
Bp- 130/90mm hg
Pr- 92 bpm
Rr- 18 cpm
Spo2- 98%
Grbs- 112 mg/dl

SYSTEMIC EXAMINATION:
Cvs-S1,S2 +
Rs-Bae+,nvbs+
P/A- soft ,nontender
Cns- nad
2D ECHO
USG PERINUM (21/1/22)
USG PERINEUM AND SCROTUM(27/1/22)

INVESTIGATIONS:
5/2/22
LIVER TESTS:
Direct Bilirubin : increased to 0.28mg/dl (0.1 -0.2)
Alkaline phosphate: increased to 315 IU/L (53 -128)
Albumin  : decreased to 3.04 g/ dl 
(3.5-5.2)

RENAL FUNCTION TESTS:
Urea   : increased to 103mg/dl  (12-42)
Creatinine : increased to 5.9mg/ dl 
(0.9 -1.3)
Uric acid : increased to 11mg/dl (3.5-7.2)
Phosphate : increased to 5.4 mg/dl 
(2.5-4.5)

HAEMOGRAM:
Haemoglobin: decreased to 9.7 ( 13-17)
Lymphocytes: decreased to 16 (20-40)
RBC Count   : decreased to 3.26M (4.5-5.5)

8/2/22
HAEMOGRAM:
Haemoglobin: decreased to 8.8
RBC     : decreased to 2.94M
MCHC : decreased to 31.4 (31.5- 34.5)

PROVISIONAL DIAGNOSIS:
CKD secondary to Gluteal abscess. 

PLAN OF TREATMENT:
Fluid restriction less than 1L /day
Salt restriction less than 2.4g/day
T.PAN 40mg PO/OD
T.NODOSIS 500mg BD
T.OROFER  PO/OD
T.AMLONG 5mg PO/OD
T.SHELCAL 500mg/OD




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