A 63-year-old male presented with abdominal distension, puffy face, severe headache, fever, breathing difficulty, and lower limb swelling. He had a history of hypertension, diabetes, renal calculi, alcohol use, and smoking. Examination found edema, fever, elevated blood pressure, wheezing, and ascites. Laboratory tests showed acute renal failure, hyperglycemia, anemia, thrombocytopenia, and electrolyte abnormalities. He was diagnosed with acute renal failure, diabetic nephropathy, hypertension, and type 2 diabetes. He was treated with diuretics, antibiotics, steroids, antihypertensives, anticoagulants, and insulin. At discharge his medications included

1. Case study on Acute Renal
Failure
21-02-14

2. • Name: X Age: 63 Sex: Male
DOA: 25/6/12 DOD: 30/6/12
• Chief complaints: C/O abdominal distension and puffy face with
C/O severe head ache.
• H/O fever with breathing difficulty X 5 days.
• Lower limb swelling X 1 month.
• H/O occasional Seizures X 2 days.
• Past medical history:
K/C/O HTN, DM X 20 years.
K/C/O Renal calculi.

3. • Past medication history:
Diltiazem – 30mg, Insulin, Metformin – 500mg
• Personal/Social history:
Alcoholic, smoker, Married.
• On examination:
• Physical examination:
Conscious/Oriented/Oedema.
Temp: 100.1ºF Pulse: 82 beats/min.
BP: 160/120 mm/Hg.
• System examination:
• CVS: S1S2+ RS: BAE(-), Wheezing+
• CNS: NFND ABD: Ascites+

4. Lab investigations
Haemoglobin 10.4g/dl 14-18g/dl
Platelet 130 x 10mm3 150-400
Blood sugar
FBS 250mg/dl 70 to 110mg/dl
Rbs 385 80-110mg/dl
PPBS 340 Less than 180mg/dl
RENAL
BUN 58g/dl 8-23mg/dl
Cr 2.8g/dl 0.6-1.2mg/dl
Na 130mmol/l 135 - 145 mmol/liter
K 4.5mmol/l 3.5 - 5.0mmol/l
Cl 94mmol/l 98 - 108 mmol/L.
Bicarb 23mmol/l 22-30mmol/L.

5. Urine analysis
Color Clear yellow
pH 6.5
Sugar Trace
Protein 84mg/dl 60-140mg/dl
ESR 20 – ½ hr 5-15mm
Diagnosis: Acute renal failure, Diabetic nephropathy, Systemic HTN, DM - II

6. DRUG CHART
DRUGS ROA DOSE DOSAGE No.OF DAYS
Inj.FUROSEMIDE IV 60mg OD X 5 days
Inj. PANTOPRAZOLE IV 40mg BD X 5 days
Neb. BUDESONIDE P/N 0.5mg Stat X 2days
T. DILTIAZEM P/O 30mg OD X 5 days
T. CLOPIDROGEL P/O 75mg OD X 5 days
T. SUPRDAYN P/O 100mg OD X 5 days
T. LEVOCETRIZINE P/O 5mg OD X 3 days
Neb. IPRATROPIUM
BROMIDE +
SALBUTAMOL
P/N 500mcg/
2.5mg
Stat X 3 days
T. GLIMEPIRIDE P/O 2mg OD X 5 days
T. METFORMIN P/O 500mg BD X 5 days
INJ. FOSPHENYTOIN IV 5U BD X 5 days

7. Discharge advice
• T. FUROSEMIDE - 40mg (OD)
• T.CLOPIDROGEL - 75mg (BD)
• T. METFORMIN – 250mg ( BD)
• Drug interactions:
• Budesonide vs Clopidrogel vs Fosphenytoin
• Budesonide will decrease the level of of clopidrogel by
affecting/intestinal enzyme CYP3A4
metabolism.(significant-monitor closely)