VANDANA REDDY

A 35 year old man came to our hospital for continuation of Maintenance Hemodialysis. 

The patient first developed hematuria, red casts in urine and decreased urine output 1 year ago. These symptoms gradually progressed and he also started developing frothy urine. He denied nocturia, polyuriaz chyluria, dysuria or pyuria. He also denied history of fevers, weight loss or myalgias at that point. 

This clinical syndrome progressed to a point where his urine output was reduced to a few ml. 

At this point he sought a consultation with a nephrologist where he was diagnosed to have ESRD and also secondary hypertension. 

The patient was on Hemodialysis at Hyderabad Kidney Centre and also got an AV Fistula on his left forearm. 

Expenses there proved troublesome and since the last 4 months he has been occasionally coming to this hospital for hemodialysis. 

Since the last 4 months, the patient started having loss of appetite and weight loss. He says that he had loss of appetite prior to initaition of dialysis, however it used to improve post dialysis. This time his loss of appetite and loss of weight (involuntary) was associated with low grade fevers. No history of night sweats, no cough or expectoration, no seasonal or diurnal or nocturnal variant cough or expectoration. No history of wheezing. 

Patient reports that he used to have frequent sinusitis earlier, with nearly 5 to 6 paroxysms per year. He also reported multiple episodes of anterior nose bleeds and also 2 episodes of hemoptysis a few years ago.