He had some suspicious shadows in his chest X-ray (attached) and was treated with 6months of antitubercular therapy from the government DOTs program.
He also had glomerular injury and azotemia at the same time that perhaps got buried in the prominent attention garnered by the stones as well as his pulmonary tuberculosis!
The question here is what is the association between renal stones and glomerular injury?
Review 1:
Recent studies have elucidated additional pathways whereby calcium oxalate crystals can cause acute injury, implicating innate immunity and intracellular inflammasome pathways.
Unquote: https://pmc.ncbi.nlm.nih.gov/articles/PMC4096690/
Last admission EMR summary (discharged today):
Age/Gender : 36 Years/Male
Address :
Discharge Type: Relieved
Admission Date: 07/01/2025 04:25 PM
Diagnosis
Acute on chronic glomerular injury
AGN on CGN
K/C/O HTN SINCE 1 YEAR
PAST H/O PTB 1 YEAR BAC
Case History and Clinical Findings
C/O FACIAL PUFFINESS SINCE 10 DAYS
HOPI
PATIENT WAS APPARENTLY ASYMPTOMATIC 10 DAYS AGO THEN HE DEVELOPED FACIAL PUFFINESS SINCE 10 DAYS
NO H/O PEDAL EDEMA , DECREASED URINARY OUTPUT , SOB
KNOWN CASE OF CKD WITH HD IN MARCG 2024 AND THEN CHANGED TO CONSERVATIVE KNOWN CASE OF CAD SEVERE LV DYSFUNCTION MARCH 24
K/C/O HTN SINCE MARH 24 (I YEAR) N/K/C/O DM II , EPILEPSY , ASTHMA CVA , P/H/O PTB SINCE 1 YAER BACK GENERAL EXAMINATION :
PATIENT IS C/C/C
NO PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, EDEMA BP: 130/80 MMHG
PR: 88 BPM
RR: 20 CPM
SPO2: 99%
GRBS- 109 mg/dL SYSTEMIC EXAMINATION
CVS- SI, S2 HEARD, NO THRILLS, NO MURMURS RS- BAE +
ABDOMEN- SOFT, NON TENDER CNS- NFND
USG DONE ON 8/1/25
IMPRESSION - GRADE I RPD CHANGES IN B/L KIDNEYS WITH RENAL CORTICAL CYSTS LT RENAL RENAL CALCULI
Investigation
HB-11.4 TC-9000
N/L/E/M/B- 56/31/05/08/00 PCV-35.1
MCV-72.2
PLT COUNT-2.63
SMEAR - NORMOCYTIC NORMOCHROMIC
LIVER FUNCTION TEST (LFT) 07-01-2025 04:51: PM Total Bilurubin 0.50 mg/dl 1-0 mg/dl Direct Bilurubin 0.16 mg/dl 0.2-0.0 mg/dl (AST) 20 IU/L 35-0 IU/LSGPT(ALT) 17 IU/L 45-0
IU/LALKALINE PHOSPHATASE 343 IU/L 128-53 IU/LTOTAL PROTEINS 7.1 gm/dl 8.3-6.4
gm/dl ALBUMIN 4.00 gm/dl 5.2-3.5 gm/dl A/G RATIO 1.29
COMPLETE URINE EXAMINATION (CUE) 07-01-2025 05:28:PM COLOUR Pale yellow APPEARANCE Clear REACTION Acidic SP .GRAVITY 1.010ALBUMIN ++SUGAR Nil BILE SALTS Nil BILE PIGMENTS Nil PUS CELLS 5-6LLS 3-4RED BLOOD CELLS Nil CRYSTALS Nil CASTS Nil AMORPHOUS DEPOSITS Absent OTHERS Nil
24 HR UPCR -2.47
24 HR URINE PROTEIN- 1485
24 HR URINE CREATININE -0.6
SERUM ELECTROLYTES (Na, K, C l) 07-01-2025 05:28:PMSODIUM 139 mmol/L 145-136
mmol/LPOTASSIUM 4.7 mmol/L 5.1-3.5 mmol/LCHLORIDE 104 mmol/L 98-107 mmol/L
BLOOD UREA 08-01-2025 05:31:PM 61 mg/dl 42-12 mg/dl SERUM CREATININE 08-01-2025
05:31:PM 3.3 mg/dl 1.3-0.9 mg/dl
SERUM ELECTROLYTES (Na, K, C l) 08-01-2025 05:31:PM SODIUM 141 mmol/L 145-136
mmol/LPOTASSIUM 5.3 mmol/L 5.1-3.5 mmol/LCHLORIDE 105 mmol/L 98-107 mmol/L
BLOOD UREA 09-01-2025 05:31:PM 61 mg/dl 42-12 mg/dlSERUM CREATININE 08-01-2025
05:31:PM 3.3 mg/dl 1.3-0.9 mg/dl
SERUM ELECTROLYTES (Na, K, C l) 08-01-2025 05:31:PM SODIUM 141 mmol/L 145-136
mmol/LPOTASSIUM 5.3 mmol/L 5.1-3.5 mmol/LCHLORIDE 105 mmol/L 98-107 mmol/L
BLOOD UREA 10-01-2025 05:31:PM 62 mg/dl 42-12 mg/dl SERUM CREATININE 08-01-2025
05:31:PM 3.2 mg/dl 1.3-0.9 mg/dl
SERUM ELECTROLYTES (Na, K, C l) 10-01-2025 05:31:PM SODIUM 141 mmol/L 145-136
mmol/LPOTASSIUM 5.2 mmol/L 5.1-3.5 mmol/LCHLORIDE 104mmol/L 98-107 mmol/L LIPID PROFILE -
TOTAL CHOLESTROL-148 MG/DL TRIGLYCERIDES -194 MG/DL HDL-43.4 MG/DL
LDL -38.8 MG/DL USG DONE ON 8/1/25
GEADE 1 RPD CHANGES IN B/L KIDNEY WITH RENAL CORTICAL CYSTS BACTERIAL CULTURE AND SENSITIVITY
URINE FOR CELLS - NO PUS CELLS SEEN
BLOOD FOR CELLS - NO GROWTH AFTER 48 HRS OF AEROBIC INTUBATION
LT RENAL CALCI
REVIEW USG WAS DONE 0N 11/1/25 RT KIDNET -8.4X3.2CM
LTKIDNEY 9X3.5 CM
SUBUNTIMETRIC B/L RENAL CORTICAL CYSTS
B/L GRADE 1 RPD CHANGES WITH SIMPLE RENAL CORTICAL CYSTS NEPHROLOGY OPINION
WAS TAKEN IN VIEW OF AKA ON CKD ON 11/1/25 AND ADVICED FOR CONSERVATIVE MANAGEMENT AND REVIEW AFTER 1 MONTH
Treatment Given (Enter only Generic Name)
FLUID RESTRICTION <1.5 L /DAY SALT RESTRICTION <2 G / DAY
TAB CIPROFLOXACIN 200 MG PO/BD TAB NODOSIS 1000 MG PO/BD
TAB CINOD -MT 10/50 MG PO/OD /8 AM TAB SHELCAL-CT PO/OD/2 PM
SYO URIKIND KM 10 ML 1 GLASS OF WATER PO/TID TAB LASIX 20 MG PO/OD
TAB PAN 40 MG PO/OD/7 AM
Advice at Discharge
FLUID RESTRICTION <1.5 L /DAY SALT RESTRICTION <2 G / DAY
TAB CIPROFLOXACIN 200 MG PO/BDX 3 DAYS TAB NODOSIS 1000 MG PO/B (TO BE CONTINUED)
TAB CINOD -MT 10/50 MG PO/OD /8 AM (TO BE CONTINUED) TAB SHELCAL-CT PO/OD/2 PM X 5 DAYS
SYO URIKIND KM 10 ML 1 GLASS OF WATER PO/TID (TO BE CONTINUED) TAB LASIX 20 MG PO/OD (TO BE CONTINUED)
TAB PAN 40 MG PO/OD/7 AM X 5 DAYS (TO BE CONTINUED)
Follow Up
REVIEW TO GM OPD AFTER 1 WEEK/SOS
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR ATTEND EMERGENCY DEPARTMENT.
Preventive Care
AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE,DONOT MISS MEDICATIONS. In case
of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact: For Treatment Enquiries Patient/Attendent Declaration : - The medicines prescribed and the advice regarding preventive aspects of care, when and how to obtain urgent care have been explained to me in my own language
SIGNATURE OF PATIENT /ATTENDER SIGNATURE OF PG/INTERNEE SIGNATURE OF ADMINISTRATOR SIGNATURE OF FACULTY
Discharge Date
Date:11/01/25
Ward: MMW Unit: II
Second admission:
Admission Date: 07/05/2024 02:10 PM
Date of Operation
14/05/24
Treating unit
Urology
Diagnosis
LEFT RENAL CALCULUS WITH B/L DJ STENT INSITU PROCEDURE: LEFT RIRS + LEFT DJS UNDER GA
Case History and Clinical Findings
K/C/O CKD, PTB, CHF, HTN ON MEDICAL MANAGEMENT K/C/O B/L RENAL CALCULI, B/L DJ STENT ON 20/03/24 RIRS + R DJS ON 13/04/24
C/O DYSURIA AND VOMITINGS SINCE 3 DAYS
NO H/O LOIN PAIN , FEVER, HEMATURIA, TURBIDURIA, GRAVELURIA. CT KUB DONE ON 18/03/24
RIGHT KIDNEY- 8.4CM , MULTIPLE CALCULI LARGEST 8MM UPPER POLE (1000 HU) , 7MM MIDPOLE (500 HU) , 7MM LOWER POLE (700 HU), 5MM MIDPOLE (500 HU), 7MM LOWER POLE (800HU)
PULMONOLOGY OPINION ON 10/4/24
THEY ADVISED TO CONTINUE ATT AS ADVISED AND NEBULIZTION DUOLIN AND BUDECORT SOS
NEPHROLOGY OPINION ON 15/4/24
SUGERY CAN BE DONE WITH MODERATE RISK AND EXPLAINED TO PATIENT
Investigation
COMPLETE BLOOD PICTURE (CBP) 06-05-2024 03:42:PM HAEMOGLOBIN8.7 gm/dl TOTAL COUNT5400 cells/cummNEUTROPHILS45 %LYMPHOCYTES45 %EOSINOPHILS05
%MONOCYTES05 %BASOPHILS00 %PLATELET COUNT2.28SMEARmicrocytic hypochromic anemia
COMPLETE URINE EXAMINATION (CUE) 06-05-2024 03:42:PM COLOUR Pale yellowAPPEARANCEClearREACTIONAcidicSP.GRAVITY1.010ALBUMIN+++SUGAR Nil BILE SALTS Nil BILE PIGMENTS Nil PUS CELLS4-5EPITHELIAL CELLS2-3RED BLOOD CELLS Nil CRYSTALS Nil CASTS Nil AMORPHOUS DEPOSITS Absent OTHERS Nil
LIVER FUNCTION TEST (LFT) 07-05-2024 04:59:PM Total Bilurubin2.7 mg/dl Direct Bilurubin1.60 mg/dl SGOT(AST)60 IU/LSGPT(ALT)17 IU/LALKALINE PHOSPHATASE215 IU/LTOTAL PROTEINS7.1 gm/dlALBUMIN4.1 gm/dl A/G RATIO1.43BLOOD UREA07-05-2024 04:59:PM136
mg/dl
SERUM CREATININE07-05-2024 04:59:PM3.2 mg/dl
BLOOD UREA07-05-2024 04:59:PM136 mg/dl SERUM ELECTROLYTES (Na, K, C l) 07-05-2024 04:59:PM SODIUM135 mmol/LPOTASSIUM4.8 mmol/LCHLORIDE103 mmol/L
SEROLOGY - NEGATIVE
Treatment Given (Enter only Generic Name)
OPERTION NOTES: DONE ON 14/05/24
PROCEDURE: LEFT RIRS + LEFT DJ STENT UNDER GA
UNDER SAP UNDER GA PARTS CLEANED AND DRAPPED IN LITHOTOMY POSITION CYSTOSCOPY DONE, B/L DJ STENT REMOVED
LEFT URETERIC ORIFICE CANNULATED WITH 0.035 GUIDEWIRE AND ACCESS SHEATH 11F/9.5 PLACED
LEFT FLEXIBLE URETERORENOSCOPY DONE, MEASURING 5-7MM IN ALL POLES LEFT RIRS DOEN AND STENT PLACED
16FR FOLEYS PLACED POST OP INSTRUCTIONS:
1. NBM TILL FURTHER INSTRUCTIONS
2. VF RL/NS/DNS @ 50ML/HR
3. INJ. PIPTAZ 2.25G IV/BD
4. INJ. PCM 100ML IV/TID
5. INJ. PAN 40 MG IV/OD
6. INJ. ONDEM 4MG IV/SOS
7. INJ . TRAMADOL 50MG/IV/SOS
Advice at Discharge
INJ.PIPTAZ 2.25G IV BD FOR 5 DAYS
FOLLOWED BY TAB AUGMENTIN 625MG PO/BD X 1 WEEK TAB PAN 40MG PO/OD BBF X 1 WEEK
TAB PCM 650MG PO/TID X 5 DAYS TAB LIMCEE PO/OD X 10 DAYS TAB.MVT PO/OD X 10 DAYS
TAB.NODOSIS 500MG PO/BD X 1 MONTH CAP.BIO D3 PO/OD X 1 MONTH CONTINUE HTN MEDICATION CONTINUE ATT
CONTINUE CARDIAC MEDICATION
Follow Up
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR ATTEND EMERGENCY DEPARTMENT.
REVIEW AFTER 1 WEEK TO UROLOGY OPD
When to Obtain Urgent Care
AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE,DONOT MISS MEDICATIONS. In case
of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact: For Treatment Enquiries Patient/Attendent Declaration : - The medicines prescribed and the advice regarding preventive aspects of care ,when and how to obtain urgent care have been explained to me in my own language
SIGNATURE OF PATIENT /ATTENDER SIGNATURE OF PG/INTERNEE SIGNATURE OF ADMINISTRATOR SIGNATURE OF FACULTY
Discharge Date Date:16/05/24 Ward: MSW Unit: UROLOGY
The chest X-ray that made him get started on antitubercular therapy by our pulmonology department on
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