65 years old who is a
retiree, previously worked as primary school teacher
and he is from Sungai Rambai, Melaka. He started renal
dialysis 5 months back (9-12-2005), three times a week
and 4 hours each session. Patient never misses any
session since the beginning. In year 2004 he was
diagnosed with bladder stone and because of this
patient had difficulty in urination and burning
sensation during micturation and there was no
haematuria. Then an operation done to remove the
stone. But few weeks later, patient suffered the same
problem again, difficulty in urination and decrease
urine output. Later patient was diagnosed with renal
stone on both the left and right kidney then patient
underwent an operation to remove the stones. One day
after operation, patient suddenly felt very weak,
malaise, loss of appetite and also short of breath.
Later doctor told him that his kidneys are were
shrunken and only 10% of the kidneys can function
only. Initially patient and his family members can’t
accept the fact and they were very sad and worry. They
worried that they can’t afford the cost of treatment,
the severity of the disease and also the outcome and
complication of the disease. But after the explanation
from the doctor and the better understanding of the
disease, they start to accept it and started his
dialysis. Also, the renal dialysis fees will be
supported by the government and they no longer worry
of the expensive bill anymore. At the same time
patient and his family members become more optimistic
about his disease and they willing to face the problem
together. Initially patient underwent peritoneal
dialysis for 3 episodes and then after the AV fistula
become matured, he started his renal dialysis. During
this five months never felt any difficulties because
of the dialysis and patient feels happy that because
of the dialysis, now he becomes healthier and no more
feeling of tiredness and breathlessness. Every time
when he needed to come for dialysis his son will fetch
him here and also bring him back afterward. So he
doesn’t have any worry for the dialysis and he only
concentrate on his dialysis only. Till now patient
doesn’t have any complication because of the renal
dialysis. In medical history, patient has gout since 4
years back and he is on medication. Patient has no
diabetes, hypertension, IHD and any lung disease. In
Family history, patient and his wife have 4 sons, it
is not significant. In personal history, patient was a
smoker for more than 30 years and one pack of
cigarettes per day. But he already stop smoking for 7
years because seven years back he suffered from a bad
cough and doctor advised him to stop smoking to
prevent further damage of the lung because of smoking.
He is a non alcoholic. Before he was diagnosed with
renal failure, he used to drink 4 glasses of water per
day which doctor suggested him to drink 8 glasses of
water per day. Then patient has a normal diet, he
doesn’t like too salty and high fat food. In drug
history, patient is on Ferrous sulfate, Vit B12,
Calcium Carbonate and folate.

Investigation (8-4-06):
Renal Profile:
Creatinine      : 743 umol/L (High)
Urea            : 19.8 mmol/L (High)
Phosphous       : 1.5 mmol/L

Hematology:
Total RBC       : 3.8 (Low)
Hb              : 12 gm/L
PCV             : 0.36 L (Low)
Polymorps       : 79% (Increase)
Lymphocytes     : 16% (decrease)
ESR             : 18 mm/hr (Increase)
Platelet count  : Normal

RFT:
Urea            : 7.5 mmol/L (increase)
Creatinine      : 327 umol/L (High)
Uric Acid       : 144 umol/L (decrease)

LFT: Normal

Lipid profile:
Triglyceride    : 3.1 mmol/L (increase)

Blood Glucose: 6.4 mmol/L

Electrolyte:
Potassium       : 3.0 mmol/L (decrease)

PTH             : 9.12 pmol/L (increase)

ECG: Normal sinus rhythm with 1st degree AV block.

Chest X-Ray:
Heart is normal. Emphysematous chest with flattened
hemi diaphragms noted. No parenchyma consolidation,
effusion or sign of failure seen.

From:
Haw Keong 8th Semester
(3-5-06 11:55pm)