Dr. Manzoor Ahmad Parry
Nephrology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
Answered by
Medically reviewed by
Patient's Query
Hello doctor,
I want to discuss a case that involves an 86-year-old woman with a ten-year history of hypertension and kidney complications, currently exhibiting the following symptoms:
Loss of appetite.
Nausea tendencies.
Mild abdominal discomfort.
Irregular bowel movements.
Urination difficulties.
General weakness.
Current medication:
Sampras-D BD.
Dilnip-M-25 BD.
AB Phyline-BD.
Dytor-10 mg OD.
Febutaz-40 mg OD.
Despite medication, her blood pressure remains high (192/94), with a pulse rate of 58. Recent blood reports indicate alarming levels of creatinine (4.11), urea (118.30), uric acid (8.30), and fasting glucose (147.80), alongside abnormal TSH (thyroid-stimulating hormone) and urine analysis findings. Just one month back she fell down and nothing serious happened, even her CT was normal. Kindly help.
Thank you.
Hello,
Welcome to icliniq.com.
I can understand your concern.
I checked her reports (attachments have been removed to protect the patient’s identity). I have a few queries:
1. What was the previous kidney function test report before this?
2. Does she have any swelling of her legs and what is her approximate urine output?
3. What about her complete blood count, has she recently done any?
Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
Below are the details regarding her recent medical records:
Previous KFT:
Creatinine: 3.36
Urea: 131.22
Urea nitrogen in blood: 61.33
Total Protein: 6.38
Total Calcium: 8.58
Sodium: 141.03
Potassium: 5.58
Chloride: 111.46
Subsequent KFT:
Creatinine: 4.8
Urea (Urease-GLDH): 224
Sodium: 130
Potassium: 4.3
Chloride: 99
She does not have much swelling in her legs, sometimes she observes swelling but it is not regular. She drinks only one liter a day, as per the local doctor's advice,and her urine output is much less. She recently had CBC done, which I am again attaching. You can observe in her recent report her TSH is 151.00.
Please advise further accordingly.
Thank you.
Hi,
Welcome back to icliniq.com.
Observing the reports (attachments have been removed to protect the patient’s identity), it appears she is in chronic kidney disease stage 5. Our approach should focus on symptom management while investigating the underlying cause. If symptoms persist without improvement, dialysis may be necessary. As she experiences nausea and vomiting tendencies, I recommend conducting a whole abdomen ultrasound, serum amylase, and liver function tests. Meanwhile, continue proton pump inhibitors and ondansetron as needed.
Addressing the high TSH (Thyroid stimulating hormone)levels, I advise Thyroxine treatment would be beneficial. Begin with 25 mcg for two weeks, followed by 50 mcg before breakfast. Reassess TSH levels after six weeks.
Regarding her reduced urine output, encourage her to consume fluids as per her thirst while adhering to a salt-restricted diet.
I hope this information will help you.
Thank you.
Patient's Query
Hello
Thank you for your reply.
I have enclosed the previously provided LFT report for your convenience.
Regarding her ongoing treatment, we have initiated Ondem MD-4 mg as advised for her symptoms.
Given her normal LFT results, could we proceed with serum amylase and a whole abdomen ultrasound (USG-WB) for further investigation?
Additionally, concerning her urine analysis showing epithelial cells in the range of 10-20 epi cells/hpf, would you recommend any specific actions or further assessments in this regard?
Thank you.
Hi,
Welcome back to iclinq.com.
The liver function test looks normal. I would suggest doing one USG (ultrasound) whole abdomen and serum amylase. Also presence of epithelial cells will not matter, at the most you can repeat one urine examination. Rest and continue previous treatment.
I hope this information will help you.
Thank you.
Was this conversation helpful?
Same symptoms don't mean you have the same problem. Consult a doctor now!
Nephrology
Related Questions
Hypertension in Children - Causes, Risk Factors, Diagnosis, and Treatment
Hypertension and Organ Damage: Understanding the Silent Threat
Are shaky hands and a fast heartbeat the after-effects of alcohol consumption?
What could cause a hard, painless, and an immovable lump on the sternum?
Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.
This website uses cookies to ensure you get the best experience on our website. iCliniq privacy policy
