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45 years old female came to OPD complaints of loss of appetite, vomiting and itching all over the since seven days.
October 22,2022

Chief complaint: patient complaints of loss of appetite and vomitings and itching all over the body since seven days.-patient was apparently asymptomatic 4 years back and developed right loin pain and fever for which she visit NIMS and she also complaints of vomitings single episode immediately after taking food.

History of present illness: -no fever-no headache-pain abdomen-chest pain -no loss of appetite since seven days.

History of past Illness: -n/k/c/o- htn,DM,asthma,and cadTreatment history:-no diabetes-no htn-no cad-no asthma-no TB-no known history of taking antibiotics and chemo therapy, radiotherapy,blood transfusionSurgeries undergone: right nephrectomy.

Personal history-married-occupation: farmer-appetite: lost-mixed diet-bowel and bladder: regular-micturition: normal- no known allergies-no addictione

Family history :No other family member had similar complaints

Menstrual history:Age of menarche: 13 yearsMenstrual cycle: 30/3-no any other gynaecological problems

Physical examination: -no pallor-no cyanosis-no icterus-no lymphadenopathy-no clubbing of fingers and toes-no pedal edema-no malnutrition-no dehydration

Vitals:Temperature: afebrilePulse rate: 84bpmRespiratory rate:16cycles/minBP: 120/80mmhg

Systemic examination: -
Cvs: no thrills and cardiac murmurs-Cardiac sounds- s1,s2 positive

Respiratory system: no dyspnea,no -wheeze.-Position of trachea- central-Breath sounds: vesicular 

abdomen- shape of the abdomen scaphoid, no tenderness,no palpable mass, hernial orifice normal, no free fluid-liver and spleen - not palpable-bowel sounds- present
Cns: level of consciousness- conscious-speech: normal-signs of meningitis: no neck stiffness                                     no kernigs signProvisional

 diagnosis: nephropathyInvestigations
;Treatment
:Tablets: lasix 40mg                Nodosis                 Shelcal                 OroferInj: iron 200mg iv(every alternate day)

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