This document presents a case study of a 39-year-old male smoker who presented with puffiness of the eyelids and face, decreased urine output, and swollen lower limbs over the past 3 months. Initial investigations showed elevated creatinine and urea levels. A kidney ultrasound showed increased echogenicity and preserved corticomedullary differentiation of both kidneys. The patient was started on Lasix, potassium supplements, antibiotics, and albumin. A kidney biopsy was performed and the results are pending. The patient's creatinine and urea levels have further increased based on recent tests.

1. Case
presentation
Dr. Abdelmoghny Mohammed
Resident of Nephrology
NMGH

2. Personal history
Name : Mahmoud Mohammed Elsayed .Age
: 39 year Sex :male . Occupation : driver
.from Belqas
Marital status : single
Special habits : smoker about 20 cigarettes
/ day for 22year .addict on tramadol

3. complaint
Puffiness of eye lids and face
Decrease urine out put
Swollen of lower limb
Easy fatigability and increase body weight

4. Present histoy
Onset : the condition started since 3 months by
early morning puffiness of eye lid that improved
after few hours then gradually increased ‘presence
of lower limb edema ‘oliguria ‘elevated of blood
pressure
No history of DM or HTN
Investigations done at time of examination Cbc :
Hb 11.4 Tlc 14.7 Plt 555

5. ABG :PH .7.29 Pco2 34 Hco3 16
S.Creatinie : 2.4 S.Urea :43 S.K :3.2
S.Na 140
INR: 1 . S. Albumin : 1.8 ALT : 25
AST: 25
Cholesterol : 198 Triglyceride : 208
LDL 36

6. Alb / creat : 36.59 mg/dl
C3 : 86 < 96 - 210 >
C4 :22 <10 -40 >
ANA : Negative

7. Urine analysis
Protein : ++
RBCs : 10 -12
Pus cells : 5 -6

8. Ultrasound of both kidney
Both kidney ; Average size
Increase echogenisity Grade II
Preserved corticomedullary
differentiation No stone No
back pressure

9. Past history
No history of HTN except during start
of illness NO history of DM
No history of other kidney disease

10. Family history
NO history of similar condition or any
kidney disease

11. Plan
Start Lasix 40 mg / 8 h
Fluid chart UOP 6000 ml /24 h input
2000 ml
KCL Syp due to hypokalemia
Ceftriaxone 1 gm /24
Prepare patient for biopsy

12. Stop lasix and start aldactone 25 mg
Clexane 20 /24 h
Albumin bottle / 24 hour
Biopsy done and waiting for result

13. Physical examination
Patiant consciuos orinted
BL p :110/70
RBG : 110
chest : bilateral basal crepitation
Heart : normal heart sound
Abdomen ; enlarged with mild ascitis
Bilateral Lower Limb pitting edema

14. Last investigations yesterday
CBC : HB . 11.8 TLC .8.8 plt .450
S. creatinine : 4.4 s.urea : 55 s. k :2.1 s.Na 140
s. Ca 7.3 PO4 5.1 s.Alb : 1.8
UA 3.2
ABG PH 7.30 Pco2 48 Hco3 :23

15. Thank
you