Mrs.Brundha shree 24 Years Female known case of prune belly syndrome .S/P bilateral ureteroneocystostomy, drethral reconstruction (1998).severe anaemia and chronic kidney disease was came with complaints of dysura and hematuria with bleeding per vagina, On evaluation showed severe renal failure (creatinine-5.43).Hyperkalemi melabolic acidosis, severe anemia (HB-3.9) with pyuria, Nephrotlc proteinuria and microhematuria. Ultrasound abdomen showed bilateral Hydrouretronephrosis with thinned out renal parenchyma with significant post void residual.Clinically diagnosis as severe renal failure, Secondary to bladder outflow obstruction,urosepsis. uterine Dieed secondary to uremic coagulopathy started on IV antibiotic(Inj. Albactum from 9/1/20) Asthalin nebulization and IV fluids.Gynocologist opinion done (Dr.Purnimaa)and managed with tranexamic acid. Hyperkalemia was managed with astalin nebulization and potassium binder. severe anaemia was managed with packed cell transfusion IV iron and darbipoitin. Urologist opinion done (Dr.Ponnusamy) suggested DPTA Renogram and adviced to continue alpha blocker and bethanecol,urine culture grown E.coli and changed to sensitive antibiotic (Inj.meropenem from 11/1/20). CT abdomen (plain) done and showed Bilateral Hydrouretronephrosis with thinned out plenal parenchyme with uterine clot. All reversible factor done for renal evaluation done. Repeat Ultrasound post void residual showed no nsignificant residual urine. Renal functions improves. Patient general condition good and discharged.
2. COURSE IN THE HOSPITAL
Mrs.Brindha sree 24 Years Female known case of purne belly syndrome / chronic kidney disease with obstructive uropathy was admitted with complaints of mennorhagia and difficulty in taking food. On evaluation patient had severe renal failure with abnormal GFR and renal parameter (Urea-95.05, Serum creatinine-5.01) from the baseline (Urea-73.4, Serum creatinine -5.08,hyperkalemia(5.8),CRP- positive,Anemia(9.9),Pyruria,Proteinuria,Microhematuria, Urine culture was sent and reported as No growth.Ultrasound abdomen shows B/L chronic kidney disease with thinned out renal parenchyma. Reversible factor for CKD was evaluvated and treated, but patient had severe renal failure with malnutrition, so initiated on hemodialysis through Right Intenal Jugular Catheter insertion on 24.01.2020 in view of hyperkalemia, IV fluid, IV antibiotic (Meropenam). Hyperkalemia was managed with k-binder nebu!lization.Astalin and other supporitive measures.And then turned to Right side PERM catheter insertion was done on 29.01.2020.The option of CAPD was considered but differed due to abdominal wall defect corrected in the past, so the plan of early Renal transplant the patient was considered and done on 29.01.2020. Father was worked up as a prospective renal donor ,started on IV iron and Erythropoeitein supplementation. Cross matched with DSA and HLA typing was sen with father as renal donor. Patient had good urine output, so planned for weekly twice Hemodialysis. Patient symptomatically better and Discharged at stable condition.