Hello Sir,
Lalitbhai Mehta From INDIA(Gujrat).
HISTORY:-

My Name is Lalitbhai Mehta .55 yr old male k/c of HTN for last 3Year .
also having hearing loss for 3 year
now due to dyspnoea on exertion n i evaluated and found to have deranged renal function and high BP. my creatinine level at the time of admision was 3 mg/dl.
i was on cyclophosphamide and steroid at the time of admission on kidney hospital which i was started 10 Day back.

no h/o skin rash , jointpain or oral ulcer.
no h/0 NSAID , or any other alternative medication
no h/o fever ,cough


O/E: My Afebrile, Pulse :90/min, regular ; RR:18/min, regular , no e/o labored breathing,
BP: 200/120 mmHg; 200/110 mmHg in standing position.
no periorbital puffiness /pedal edema /pallor
no cyanosis/ icterus /lymphadenopathy
no skin rash , joint swelling /deformities.
S/E : RS :AE=BS;

CVS:S1S2 Normal ; No murmur/LVS3
P/A: Soft , non tender , no e/o free fluid in abdomen no organomegaly
CNS: Conscious oriented
Left lower limb -power at Ankle joint -4/5 (Rest normal)
Planter -B/L Extensor


USG Scrotum :-

Ward OL
Rt. Testis:38*19mm
Rt.Testis show normal shape, contour & echogenicity.
no focal lesion seen.
Epididymis head measures -20*12mm
Areas of hypo-echogenicity with increased vascularity seen.
mild hydrocele noted.
onclusion:-Possibility of bilateral acute epidydimitis.

Course in Hospital :-

He was admitted with above mentioned complains. AT the time of admission my creatinine was 3.17 mg/dl / i had good volume of urine. as my BP was not controlled on 1ST day so Anti HTN dose was escalated.after BP control my leftrenal biopsy was done under complete aseptic precautions without any postprocedural complications. my relatives councelled regarding nature of the disease and chances of recovery after BP control . for that i was advised for regular follow up in Nephro OPD. Patient was asymtomatic and hemodyanamically stable at the time of dischrage.

Recommendations :-
Total daily oral fluid -Normal
Total salt intake =3g ; no added salt in the diet.
Regular BP check up , at least 3/week ;
BP charting (Target <130/80mmHg)
Regular follow up with the nephrologist.
Maintenance of strict personal hygiene ; avoidance of out side food.
to drink boiled water .


Medication :- Tab .Nicardia R 20mg , Tab .Arkamine 0.1mg , Tab prazopress XL5mg.


Histopathology -Nephrology

Specimen Type :- Renal Biopsy

Immuno - Fluorescence : - NO IF

Light Microscopic Examination :

14 glomeruli included in this biopsy
7 glomeruli show global sclerosis
one glomerulus shows segmental sclerosis.
Remaining glomeruli show mild increase in urinary space & increase in mesengial matrix.
capillary loops show mild thickening & wrinkling.
Tubules show patchy atrophy.
Interstitium shows patchy cell infiltrate & patchy fibrosis +1
Blood vessels show moderate myxoid intimal thickening with narrowing of lumina Arterioles show hyalinosis.


Diagnosis :

Hypertensive nephrosclerosis.

Recently i had a major heart attck .
My 2D- ECHO (whichout plate )- 2D Echocardiography Report


ECHO Finding :-

Mitral Valve :- NORMAL

AORTIC VALVE :- NORMAL

TRICUSPID VALVE :- NORMAL

PULMONARY VALVE :- NORMAL

AORTA : 24MM

LEFT ATRIUM : 28MM

LV DD /DS :-44/26MM

LV IVS /PW:

RIGHT ATRIUM :- NORMAL

RIGHT VENTRICLE :- MORMAL

IVS & IAS :- INTACT

PULMONARY ARTERY :- NORMAL
PERICARDIUM :- NORMAL

C.W/P.W/COLOUR :- MILD MR.TRIVIAL AR, MILD TR

DOPPLER FLOW MAPPING :- MVIS : VE/VA :0.6/0.9 M/S

CONCLUSION :- NORMAL LV SIZE & MODERATE LV DYSFUNCTION WITH RWMA ,REDUCED LV COMPLIANCE.


PLE GIVE ME REPLY WHAT SHOUD I DO .???
MY EMAIL ID :- YYYY@YYYY