A 46 YEAR OLD FEMALE WITH AKI WITH UTI AND B/L HIP OSTEOARTHRITIS
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March 29, 2022
Sarbesh Mishra , Roll no.: 123
Date- 29th march 2022
46 year old female a resident of Rangareddy district and a agriculture labour by occupation was transferred to the general medicine OPD with
Chief complaints:
Lower back pain (at hip joint) since 10 years.
History of presenting illness:
Patient was apparently asymptomatic 10 years back then she developed bilateral hip joint pain and difficulty in walking without support.
The pain was insidious in onset, gradually progressive.
Aggrevating factors are walking, kneeling down.
For this she visited nearby local hospital for which pain relief medication was prescribed which she didn't take regularly and only took it when she was in pain.
2 years ago the pain increased and the patient visited hospital. Pain relief medication was given which was taken regularly.
12 days ago she visited our hospital and was transferred to General Medicine department where indepth history was taken.
-C/o hip joint pain since 10 years increased 2 years ago.
-Difficulty in bending forward.
-C/o burning sensation during micturation.
-C/o weight gain since 1 year.
-C/o facial puffiness 2 months.
-No history of trauma and fever
-No history of chest pain, palpitations, shortness of breath.
PAST HISTORY:
-Not a known case of DM,epilepsy, Asthma,CVA,TB.
-Known case of Hypertension (Taking medication since one year one tablet every 3 days.)
-Known case of Rheumatoid arthritis.
Menstrual History:
-Menarche at 13 years.
-Tubectomy was done 23 years ago
-Hysterectomy was done 18 years ago.
Family history:
-No similar complaints in the family members.
Personal history
Diet - mixed
Appetite - decreased since 10days
Sleep - adequate
Urination frequency decreased
Bowel habits normal
-No addictions
-No known drug allergies
General physical examination:
The patient is concious, coherent, cooperative .
Well oriented to time, place, person.
Moderately build and moderately nourished.
Pallor - present
Icterus - absent
Cyanosis - absent
Koilonychia - absent
Lymphadenopathy - absent
Edema - present (pitting type)
Vitals:
Temperature - afebrile.
BP - 130/90 mm of Hg.
PR - 80 bpm.
RR - 14 cycles per minute.
Spo2 - 98%
On Examination:
-> Trendelenberg test - positive
-> Squat test - positive
-> Inguinal ligament tenderness - absent.
-> Hip flexion - reduction in range of motion.
-> Abduction 45°and adduction 20°-30°- pain felt and range of motion reduced.
-> Internal rotation 30°and external rotation 30°-70°- pain felt and range of motion reduced.
Systemic examination:
CVS Examination - S1,S2 heard, no murmurs, no raised JVP.
Respiratory system examination - Bilateral air entry present, normal vesicular breath sounds heard.
CNS examination - normal.
Lab Investigation findings:
22-3-22
Blood urea -51mg/dl
serum creatinine-3.2mg/dl
24-3-22
Blood urea -46mg/dl
serum creatinine-3.5mg/dl
25-3-22
Blood urea -43mg/dl
serum creatinine-3.4mg/dl
26-3-22
Blood urea -36mg/dl
serum creatinine-2.9mg/dl
COMPLETE URINE EXAMINATION
colour-pale yellow
appearance-clear
reaction-acidic
specific gravity-1.010
albumin-+
pus cell-3-4/hpf
epithelial cell-2-3/hpf
HAEMOGRAM
Hb%-8.3gm/dl
total count -10300cell/cumm
neutrophil-53%
lymphocytes-40%
eosinophils-3%
monocytes-4%
basophils-0%
PCV-24.5 vol%
MCV-89.5FL
RBC COUNT- 2.75 millions/cumm
platelet count-2.42 lakhs/cu.mm
smear-rbc normocytic normochromic
DENGUE NS1
NS1 antigen- negative
IgM-negative
IgG-negative
SERUM ELECTROLYTES
Sodium-140 mEq/L
potasium-3.6mEq/L
chloride-98mEq/L
FASTING BLOOD SUGAR-
Fasting blood sugar-182mg/dl
HbA1c-7.5%
Post lunch blood sugar-347mg/dl
Albumin level-3.5gm/dl
USG:
X-ray:
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