CDSS 13F lupus and PAJR discussion

 

[3/26, 12:19 AM] Dr.Chandana: @⁨~Patient advocate⁩ lotion apply chesara ??day 8

[3/26, 12:20 AM] Dr.Chandana: How is she now? @⁨~Patient advocate

Patient advocate:Good morning all of you. 

Yes mam last Friday lotion apply chesamu andaramu. 

She is so good. 

Wysolone started 30mg last Friday. Hcq daily 100mg-

Lasix daily morning 10mg evening 10mg Tisukuntundi. 

Kani gata mudu rojuluga Malli kallu mukhamu vapulu vastunai. Ina food bagane tintundi kani pota ubutunadi nope and ayasam konchm tagindi.

Dr.Hari Priya:Monday okasari teeskoni randi

Hospital ki

Dr.Chandana:Luggage teskoni ey randi.

Chusaka avasrm unte admit chestamu

[3/27, 4:39 PM] Rakesh Biswas Sir Gen Med Hod KiMS: Are we doing the echo right now? 👏👏

[3/27, 4:40 PM] Dr.Chandana: No sir ,done an hour back

[3/27, 4:41 PM] Sai Charan Gen Med Pg KIMS: @⁨Dr.Chandana⁩ what dose of steroid is she on..??

[3/27, 4:41 PM] Dr.Chandana: 30mg OD

[3/27, 4:42 PM] Sai Charan Gen Med Pg KIMS: Have we added any sparing agent..?? AZA..??

[3/27, 4:43 PM] Dr.Chandana: Ascites resolved by the time of discharge,but now has reaccumilated

[3/27, 4:44 PM] Dr.Chandana: @⁨Rakesh Biswas Sir Gen Med Hod KiMS⁩ we are planning for renal biopsy on Wednesday sir.So shall we wait till the biopsy report or add a steroid sparing agent now only?

[3/27, 4:45 PM] Dr.Chandana: She is using HCQ 100mg daily now

[3/27, 4:45 PM] Rakesh Biswas Sir Gen Med Hod KiMS: Can add.

[3/27, 4:46 PM] Sai Charan Gen Med Pg KIMS: @⁨Rakesh Biswas Sir Gen Med Hod KiMS⁩ should we consider this cystITIS nd cholecystITIS as a part of global systemic Inflammation or other local insult sir..?m

[3/27, 4:47 PM] Rakesh Biswas Sir Gen Med Hod KiMS: Biopsy is just for prognostication and treatment may not change much

[3/27, 4:47 PM] Dr.Chandana: Okay sir

[3/27, 4:49 PM] Sai Charan Gen Med Pg KIMS: @⁨Dr.Chandana⁩ have we done any repeat 24h UPCR after pulse therapy..?? Just to look it's effectiveness in this kid and improvement in her immune mediated Glomerular injury..?

[3/27, 4:49 PM] Dr.Chandana: Plan is to collect from tmrw mrng

[3/27, 4:50 PM] Rakesh Biswas Sir Gen Med Hod KiMS: USG cystitis may not be cystitis. Why not review the literature around the sensitivity and specificity of this USG finding? 

Cholecystitis here is again an unusual association. Is it just asymptomatic gall stones? The gall bladder edema is a non specific finding of most patients with ascites?

[3/27, 4:50 PM] Sai Charan Gen Med Pg KIMS: Thanks 👍

[3/27, 4:51 PM] Sai Charan Gen Med Pg KIMS: Sure sir will review

[3/28, 8:40 AM] Dr.Chandana: Albumin has dropped from 4-->2

[3/28, 8:43 AM] Rakesh Biswas Sir Gen Med Hod KiMS: When was this?

[3/28, 8:44 AM] Navya Lakkakula Kims GM Jnr Pg: 16-3-2023

[3/28, 8:44 AM] Rakesh Biswas Sir Gen Med Hod KiMS: Over what duration and this may also throw more light on when exactly did her glomerular injury begin

[3/28, 8:45 AM] Rakesh Biswas Sir Gen Med Hod KiMS: When did it go down for the first time?

[3/28, 8:46 AM] Rakesh Biswas Sir Gen Med Hod KiMS: If the report is true it means she developed her glomerular injury around that time for the first time

[3/28, 9:16 AM] Dr.Chandana: Only 2 LFTs are done sir

One on 16-3-2023

And yesterday s (27/3/2023)

It has gone down in between

[3/28, 9:40 AM] Rakesh Biswas Sir Gen Med Hod KiMS: Undertesting?

[3/28, 9:43 AM] Dr.Chandana: She had proteinuria 654mg/day at that time also sir(when albumin was 4)

But now it has worsened (exceeding the synthetic capacity of liver)

[3/28, 10:02 AM] Rakesh Biswas Sir Gen Med Hod KiMS: What is the 24 hour proteinuria now?

[3/28, 10:02 AM] Navya Lakkakula Kims GM Jnr Pg: Started collecting today sir

Yeah.. but post pulse therapy we don't know whether her proteinuria is increased or decreased..? Any other synthetic function ( pt inr aptt ) defect ..?