A 15 year old male patient with Acute kidney Injury

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Date of admission:8/11/2021

CHIEFCOMPLAINT:

A 15 yr old male ,studying 9 th class came to the casuality with chest pain,discomfort in breathing while lying down since 3 days

HISTORY OF PRESENT ILLNESS:

Pt was apparently asymptomatic 2 months back then he complains of vomitings 2 - 3 episodes daily associated with food particles not associated with blood ,for around 1 month 

H/O fever 2 months back associated with chills relieved with medication by 2 days 

Incidentally patient found to have urea 62 mg/dlCreatinine 8.3 went to Hyderabad. Within 1 day urea has raised to 135mg/dl and creatinine 10.7 

And started him on dialysis.5 sessions of Hemodialysis done in Hyderabad.Since then he was on hemodialysis. pt C/O SOB since 3 days during evening times which is aggravating on supine position,associated with paroxysmal nocturnal dyspnoe.

C/O chest pain on inspiration,dragging type only during episode of sob.He also C/O facial puffiness 

No C/O syncope attack

Previous reports 

PAST HISTORY:

Hypertensive since 1 month and is on Tab.AMLONG 5 mg 

History of 3 transfusions 1 month back 

Not a K/C/O DM ,Asthma ,epilepsy ,thyroid disorders 

Family History :

No H/O renal problems in their whole family.

His paternal grandfather is diabetic and hypertensive

Personal History:

Diet - mixed 

Appetite - normal 

Sleep - adequate 

Bowel movements : regular 

Bladder movements : regular 

No history of alcohol consumption or smoking history 

General Examination:

Patient is conscious, coherent , cooperative

Pallor -present 

Icterus -absent 

Clubbing-absent 

Cyanosis -absent 

Generalised Lymphadenopathy-absent 

Pedal Edema -absent 

On examination:

Vitals: 

On day 1:

Temperature : 98.6°F

BP: 140/90 mm Hg in right upper arm in supine position

PR: 76 bpm

RR: 20 cycles per minute

Spo2: 88% on room air

96% at 4 litres of O2

On day-2:

Temperature : afebrile 

Pulse rate : 96 bpm

Respiratory rate : 24 cycles /min 

BP : 140/100 mm of Hg 

SpO2 : 86 % at Room air .

GRBS : 121 mg%

Systemic Examination: 

CVS: S1,S2 heard no murmurs

RESPIRATORY SYSTEM:Bilateral Air Entry - present 

Bilateral crepitations heard at IAA and ISA.

No wheeze

Per Abdomen: 

Soft ,non tender 

Bowel sounds + 

CNS:

NAD 

Investigations :

On day 1

HEMOGRAM : 

Hb - 8.7

TLC - 7800

Neutrophils - 50

Lymphocytes - 40

Monocytes - 05

Eosinophils- 05

Basophils -00

Pcv - 25.1

RBC - 3.19

Plt - 1.2

MCV -78.7

MCH -27.3 

MCHC - 34.7 

Blood group : A positive 

Complete urine examination:

Pale yellow 

Albumin - 3+

Sugar -Trace  

Pus cells- 6 to 8 

Epithelial cells -3to 4  

FBS - 78

RFT : 

Creatinine - 9.2 

Urea - 119

UA - 5.5 

Na - 141

K - 5.6

Cl - 101

LFT : 

TB - 0.79

Db - 0.19

AST - 17

ALT - 10

ALP - 201

TP - 5.8

ALB - 3.4

A/G - 1.36

USG finding : 

Bilateral grade 1 rpd changes

Provisional diagnosis : 

Acute Kidney Injury (AKI)

Treatment :

1. Tab Lasix  40mg po/ BID

2. Neb  with  duolin ,budecort -8th hourly 

3.Tab .Zoffer - 4mg  po /TID

4. Tab .Nodosis -500mg  po /BID

5. O2 inhalation  to maintain SpO2 

6. Tab orofer AT  po /BID

7.STRICT  I/O  CHARTING 

8. BP ,PR,RR CHARTING

9.  Tab Rantac  150 mg po /OID

What might be the reason for kidney injury?