49M PROTEINURIA, BURNING MICTURITION 2 1/2 YRS

 03/11/2026

THIS PATIENT DATA WAS GATHERED BY ROLL NO 11, A BATCH 2024 AS PART OF HIS COMPETENCE BASED LEARNING EVALUATION PORTFOLIO PREPARATION

THIS CASE IS OF 49M WITH LOSS OF APPETITE, WEAKNESS, PROTEINURIA (BLOODY) BURNING MICTURITION, VOMITING, ITCHING, SEVERE BACK PAIN

Here is a clean, deidentified version:

*Case History*

- *Age / Sex:* 49 years / Male

- *Admission:* 2 1/2 years ago, weekly 3 times

*Chief Complaints*

- Loss of appetite, weakness, proteinuria (bloody)

- Burning micturition, vomiting, itching, severe back pain

*Present Illness*

- Patient is symptomatic

*Dialysis History*

- Loss of appetite

- Weakness

- Chills

- Anuria

- 3 times / week

- 2 failed fistula; chest fistula at present

*Past Illness*

- HTN

- No DM / Asthma / Seizures

- Biopsy kidney

*Personal History*

- Sleep: Decreased

- Appetite: Decreased

- Alcohol: Addictions

- Bowel / Bladder: Regular

- Diet: Mixed

Here is a clean, deidentified version:

*Medications*

- BP Tabs - Telmisartan

- Paracetamol

- Due to burns, tendons contracted

- Furosemide - Diuretics

- Aspirin, Rosuvastatin

- Levocarnitine & B12 Inj - Before dialysis

*General Examination*

- Patient conscious, coherent

- P - Pallor: Absent

- I - Icterus: Absent

- C - Cyanosis: Absent

- C - Clubbing: Absent

- L - Lymphadenopathy: Absent

- E - Edema: Present - Pitting

*Vitals*

- BP: 103/67 mmHg

- HR: 93 bpm

- SpO2: 93

- Temperature: Normal

*Diagnosis*

- CKD Stage V

Here is a set of Socratic questions based on the clinical case for medical student learning and case-based discussion:

1. Pathophysiology & Diagnosis

 * What is the significance of proteinuria (bloody) combined with symptoms like weakness, vomiting, and severe back pain in a patient with a multi-year history, and how does this lead to a diagnosis of CKD Stage V?

 * Why do patients with advanced chronic kidney disease experience symptoms such as anuria, loss of appetite, and severe itching (uremic pruritus)? What metabolic imbalances drive these clinical manifestations?

2. Complications & Clinical Findings

 * The patient presents with pitting edema and a blood pressure of 103/67\text{ mmHg} alongside a past history of hypertension. How can chronic hypertension both be a cause and a consequence of renal parenchymal disease?

 * Given that the patient's vitals show an SpO2 of 93% and a heart rate of 93\text{ bpm}, what common hematological or cardiopulmonary complications of end-stage renal disease should you look out for?

3. Management & Treatment

 * The patient is undergoing hemodialysis 3 times per week and currently utilizes a chest fistula after two failed peripheral fistulas. What are the advantages and long-term vascular access challenges associated with hemodialysis?

 * Review the patient's medication list (e.g., Telmisartan, Furosemide, Aspirin, Rosuvastatin, Levocarnitine, and B12 injections). What is the specific rationale for administering diuretics like furosemide or supplements like levocarnitine in a patient who is already anuric and on regular dialysis?