• acute pyelonephritis

• Cystitis (bladder)

• Renal stone

• UTI

• Hydronephrosis (due to obstruction)

• Cancer (renal tumour)

• Appendicitis

• Pelvic inflammatory disease

• Ovarian cyst

  
  

Further questioning

1.Hopi

• Site:bilateral or unilateral

• Onset: when notice this sx

• Characteristics: dull/sharp pain, color of urine, any burning pain

• Radiate: it radiate to where

• Associated sx: fever, weight loss, haematuria, any suprapubic pain

• Times: duration of pain

• Exacerbates: any movement

• Severity: rate the scale

Past medical history

• history of dm/hypertension

• Any inherited disease

• Any frequence history of admition

• Any medication (side effect)

Past social history

• alcohol- dehydration (reduce blood flow/trigger ckd)

• Smoking- immune dysfunction

• low immune system

• Post menopause- risk for uti

Flank pain

• pain at side btw rib and hip

• Indicate kidney problem

Fever

• infection

Painful micturition

• any obstruction

- revealed that continuous fever - infection(UTI),

• moderate dull left flank pain - left sided infection, not cause due to obstrutcion

• the passing of cloudy urine associated

with dysuria started a week ago. - due to infection, dehydration, UTI, or kidney stones

• The dysuria was described as burning

pain during micturition - classic desc dysuria,

Past medical history

• The patient had a history of diabetes mellitus for the last 13 years - long term increase risk of infection due to impair immune system, high glucose promote growth bact, sorbitol accumulation

• first controlled with oral medications, but now requiring daily insulin injections -

• The patient admitted that her diabetes control was poor. Also,

• the patient had a previous history of hypertension controlled by propranolol - long period can contribute to renal changes,

• She was treated before for bladder infections.

• Medications and allergies. There were no known allergies revealed - symptom not cause by allergies,

• Social history. There was no history of smoking, alcohol consumption or

drug abuse - no neph toxic symptom

• acute pyelonephritis

• Cystitis (bladder)

• Renal stone

• UTI

• Hydronephrosis (due to obstruction)

• Cancer (renal tumour)

• Appendicitis

• Pelvic inflammatory disease

• Ovarian cyst

further exam :

• vital sign

• BMI

• phy exam

• Temperature 39.0 ºC 36.6 – 37.2ºC

• Heart rate 100 beats per minute 60 – 100 beats per minute

• Respiratory rate 16 breaths per minute 12 – 16 breaths per minute

• Blood pressure 130/84 mmHg 120/80 mmHg

• BMI 24 kg/m2 (normal range: 18.5 – 24.9 kg/m2)

• On physical examination, no peripheral oedema was found - not chronic(kidney still dpt diselamatkan)

Examination of the abdomen

• The abdomen was soft, liver and spleen were not palpable.

• Mild suprapubic pain without rebound tenderness was present.

• there was a moderate left renal angle tenderness,

• Left kidney ballottement was revealed on palpation - kidney enlarge (due to accumulation of fluid and inflammatory cell accumulate sebabkan oleh edema)

• acute pyelonephritis

• Cystitis (bladder)

• Renal stone

• UTI

• Hydronephrosis (due to obstruction)

• Cancer (renal tumour)

• Appendicitis

• Pelvic inflammatory disease

• Ovarian cyst

further exam :

• FBc

• RFT

• urinalysis

• urine C & S

• radionuclide scanning

• 
  

Total WBC count 13.0 x 109/L 4 – 11 x 109/L

Differential WBC count :

▪ Neutrophils 11.05 2.5 – 7.2 x 109/L

▪ Lymphocytes 1.5 1.5 – 3.5 x 109/L

▪ Monocytes 0.52 0.2 – 0.8 x 109/L

▪ Eosinophils 0.26 0.1 – 0.5 x 109/L

▪ Basophils 0.13 0 – 0.1 x 109/L

Platelets 250 x 109/L 150 – 450 x 109/L

Glucose 237 mg/dL 100 – 125 mg/dL

Serum creatinine 120.8 μmol/L 71 – 117 μmol/L

Blood urea 8.7 mmol/L 1.8 – 7.1 mmol/L - kidney problem jdi takleh buang

Urinalysis

▪ Blood ++ Negative

▪ Nitrite ++++ Negative

▪ Leukocyte esterase +++ Negative

▪ RBCs 5 – 10cells/hpf Negative

▪ WBCs >41 cells/hpf <2 cells/hpf

▪ Protein ++ Negative

▪ Glucose ++ Negative

▪ Bacteria +++ Negative

▪ WBC casts Present Negative

• Imaging studies: A KUB (kidneys, ureters, bladder) x-ray revealed a

radiopaque calculus involving the entire pelvicalyceal system of the left kidney.

• Urine culture and antibiotic sensitivity: results will be discussed later.

Management.

• The patient was placed on bed rest. After specimens for urine cultures were taken, empiric antibiotics were administered.

• However, the next day, she noted an acute worsening of her left flank pain, and she remained

febrile.

• Performed renal ultrasound of both kidneys showed left renal hydronephrosis and radionuclide scanning (DMSA) revealed a non-functional left kidney

• The patient was diagnosed with nephrolithiasis, complicated with

hydronephrosis and acute pyelonephritis.

• The patient underwent an elective

left nephrectomy, compromised function and the extent of stones.given the

• During the procedure, dense adhesions of kidney and psoas muscle along with

marked perinephritis were noted.

• On longitudinal bisection of the left kidney, a large staghorn calculus was observed obstructing the proximal ureter with

considerable dilation of the left pelvicalyceal system, and scattered papillae

have a grey-white discolouration. Histological investigation of the papillae and

cortex showed necrotising papillitis. The patient recovered well after surgery.

Urine cultures taken before surgery grow Proteus, and her antibiotic regimen

was adjusted. She was discharged after two weeks