55 year old male patient came with loin pain , fever and severe iching of skin all over the body

General medicine 
Hi i am KALPAK MAWALE 3rd sem This is an online E logbook to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through a series of inputs from the available global online community of experts intending to solve those patients' clinical problems with collective current best evidence-based inputs

Cheif complaint -
55 year old male patient came to OPD with chief complaint of 
Loin pain since 3 months
Server iching of skin all over the body since 3 month
Fever since 5 days 

 History of present illness-
Patient was asymptomatic 3 months before
Then he developed loin pain radiating towords back of neck also severe iching of skin all over the body  which develops small white spots
Then he developed fever 5 days back before came to OPD and shortness of breath 4 days back

History of past illness -
H/o DM from 2 year
H/o hypertension from 1 month
No H/o asthama , TB, epilepsy 

Personal history -
married
Mix diet
Appetite normal
Bowel movement regular
Frequent urination 
No allergies
No h/o alcohol
No h/o smoking

Family history -
Father is having asthama

General examination -
Conscious and cooperative 
Coherent
No pallor
No icterus
No cyanosis
No lymphadenopathy 
NoPedal edema

Vitals-
Temp: 95.9⁰F
BP: 130/70 mm of Hg
Pulse: 69bpm
RR: 16cpm
SpO2: 100% at room temp
GRBS: 121 mg/dl

Systemic examination -

CVS:
Cardiac sounds: S1 and S2
No thrills
No cardiac murmurs

RESPIRATORY SYSTEM:
No dyspnea
No wheeze
Central location of trachea
Vesicular breath sounds

ABDOMEN-
Abdomen is scaphoid
No tenderness
No palpable mass
Non palpable liver and spleen
Bowel sounds are not heard

CENTRAL NERVOUS SYSTEM 
Conscious 
Speech- normal
Signs of meningeal irritation - 
no neck stiffness
no kerming's sign
Cranial system - intact 
Motor system - intact 
Sensory system - intact 
 Cerebeilar signs
    Finger nose- in coordination
    Knee heel - in coordination

Provisional diagnosis -
Chronic renal failure
Hypertension 
DM

Investigation -
Hemogram, CBP, serum creatinine, ultrasound,2D echo, blood urea,ECG, serum electrolyte
Treatment -
Hemodialysis
Blood transfusion 

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