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c/c-
Rise in serum creatinine incidentally detected onroutine checkup
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Past history-
No history of diabetesmellitus,hypertension,asthma,TB
H/O DESI MEDICATION INTAKE FOR WEIGHTREDUCTION PRESENT(6 MONTHS)
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Family history-
Father died of intracranial hemorrhage 8yrs back.hehad a h/o hypertension
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General examination-
Patient is obese
BMI-31.10
BP-130/90mm right arm supine position PR-76/min
Afebrile
RR-16/min
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Mild pallor
No
jaundice
Clubbing Cyanosis
Pedal edema = +nt
No skin changes
LAP
JVP not raised
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CNS-
Higher motor functions within normal limits
Reflexes all present
CVS-
S1 S2 normal
No S3 No murmurs
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Urine exam-
Proteinuria-+2
80-100 RBC/hpf
Pus cells-nil
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Hemoglobin 9.2
TLC 4.79
UREA 190
CREATININE 7.46
VIRAL MARKERS NONREACTIVE
24HR URINE PROTEINS 7.7GMS/24HOURS
P-ANCA +VE
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21/9/13 23/9/13 24/9/13 27/9/13
TLC 4.46 4.4 10.6 13.6
Hb 6.7 6.1 9.2 10.7
Platelets 135 169 46 70
Urea 201 138 127 167
Creatinine 8.25 5.7 5.4 7.00
Na/k 134/5.39 136/5.38 140/4.9 138/4.8
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Urine routine-
Albumin-2+
RBCs-60-70
Pus cells-35-40
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Ecg-within normal limits
Chest xray-within normal limits
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Ultrasound abdomen
Right kidney-9.6cms
Left kidney-9.2cms
CMD maintained Fatty liver
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Provisional diagnosis-
Rapidly progressive glomerulonephritis
1.Anti GBM disease
2.Double positive disease
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RENAL BIOPSY-
Showed 30 glomeruli,22 out of which showedpresence of crescents(9 cellular,7 fibrocellular,6fibrous in nature)
Few showed partial sclerosis and,partial to totalsclerosis
Tubulesshowed degenerative changes with tubularatrophy and compensatory dilitation of the rest
Blood vessels showed thickenedvessel wall
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Immunoflorescence-
Linear deposits of IgGand weak complement(C3)along glomerular capillary basement membranenoted.
Fibrinogen positive in few of the crescents.
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