Medicine case discussion


The queries that I encountered in a 65 year old female  patient Pre renal AKI with Urosepsis with hypoalbuminemia and  k/c/o DM type 2 , HTN with Grade 2 fatty liver. 

 1. What was the cause for AKI ?
    The patient was k/c/o osteoarthritis knee of both legs since 15 years. She has been using medication for pain since 15 years which could have damaged her kidneys to a extent. 

 Other causes of AKI 
   -Pre Renal :
     Impaired perfusion :-  cardiac failure 
                                        Sepsis 
                                         Blood loss 
                                        Dehydration 
                                        Vascular occlusion 
  -Renal : 
         Glomerulonephritis with small vessel Vasculitis 
          Acute tubular necrosis 
          Drugs 
          Toxins
          Inflammatory diseases 
          Infection 
 -Post Renal : 
        Urinary calculus 
        Bladder cancer 
        Prostate cancer 
        Cervical cancer 
        Urethral stricture 

 2. What was the indication for dialysis in this patient ?
    The patient underwent dialysis for three times 
- Patient was sent to dialysis on 21/05/2020 , indication being anuria. 
- Patient was sent to dialysis 26/06/20 due to increased blood urea and serum creatinine.( blood urea : 173mg/dl, serum creatinine : 5.5mg/dl)
- Patient was sent to dialysis 01/07/20 due to increased blood urea and serum creatinine.

 Indications for dialysis :-

 Acute indications :- 
1. Acidemia from metabolic acidosis in situations in which correction with sodium bicarbonate is impractical or may result in fluid overload
2. Electrolyte abnormality, such as severe hyperkalemia, especially when combined with AKI.
3. Intoxication, that is, acute poisoning with a dialyzable substance. 
4. Overload of fluid not expected to respond to treatment with diuretics 
5. Uremia complications, such as pericarditis, encephalopathy, or GI bleeding.

Chronic indications :-
 1. Symptomatic kidney failure 
 2. Low glomerular filtration rate   (GFR < 15 mL/min).

 3. What was the cause for grade 2 fatty liver ? 
   Obesity and type 2 diabetes mellitus are the major risk factors for the development of fatty liver in this patient. 

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