Md. Nazmul Islam¹, Mohammad Sadik², Mizanur Rahman³
1. Associate Professor and Head, Department of Nephrology, North East Medical College, Sylhet
2. Assistant Registrar, Department of Nephrology, North East Medical College, Sylhet
3. IMO, Department of Nephrology, North East Medical College, Sylhet
Joynob Akter, a 28 year-old female house wife hailing from Sylhet, Bangladesh admitted in North East Medical College Hospital on 2/19/14 through emergency with the complained of vomiting, headache, anorexia, chest tightness, low back pain and fever for 1 day.
According to the patient’s statement she was otherwise well when she developed the above symptoms. Before admitting hospital, she had history of obstructed labour and post partum haemorrhage (PPH). The vomitus contains fluid, undigested food particles. Vomiting was not foul smelling, non projectile and not blood stained.
She also complains about swollen leg, and abdomen with low urine output (both in frequency and amount). On investigation B/P 160/110 mmhg or 170/110 so on, pulse 92/min, temperature 101F, resp 20 b/min and 24 hour urinary protein appeared 1 plus (+) in dipstick & Hb 7.6 gm/dl. She had a serum creatinine of 7.3 mg/dl. In spite of conservative treatment of hypovolumeia by blood transfusion & I.V fluid infusion, her creatinine worsened to 9.8. mg/dl.
Considering her history and clinical conditions which was suggestive of acute kidney injury, she was advised renal replacement therapy and accordingly haemodialysis was started. After completing 5 sessions of haemodyalysis, her condition improved. She also developed abscess and was treated by excision drainage. By this time patients had a dilatation and curettage. Finally she recovered without further complications. The patient was discharged on 01/03/2014.