Audit for the month October-2023

Presented by-
Dr. Tahmina Haque
Research Assistant
Paediatric Nephrology , NIKDU.
• Total working days: 26 days
• Total OPD patients :442
• Total Admission : 74 (Ward-10)
• Total Discharge : 50
• Mortality-01
 Procedures:

• Femoral Catheter-01
• Gastric lavage-03
 No of RRT in last month
(Haemodialysis)

Name Sex Age Dx Session of HD

Jannat 10y F RPGN 5

Tanzina 9y F CKD(St-5) 12
Working Days & No.of admitted patients in
last 3m
90
80 79
74
70 65
60
50
Working Days
40 Admission
30 25 26
23
20
10
0
Aug'23 Sep'23 Oct'23
 No of OPD patients in last 3m
540
527
520

500

480 484

460 OPD pts

440 442

420

400

380
Aug'23 Sep'23 Oct'23
Nephrotic Syndrome (Initial 38 8.6%
episode)
IFRNS(ARI,UTI,Peritonitis,AWD) 46 10.4%
FRNS(ARI,UTI,Peritonitis,AWD) 44 9.9%
SDNS(Steroid Toxicity,HTN) 38 8.5%
SRNS 01 0.2%
Nocturnal Enuresis 06 1.3%
UTI 32 7.2%
AKI 03 0.6%
CKD 06 1.3%
PIGN 08 1.8%
Histopathologically No. %age
diagnosed cases
LN 04 0.6%

FSGS 01 0.4%

MCD 03 0.8%

IgAN 02 0.4%

MesPGN 01 0.4%
 Patients referred to Paediatric Urology Dept. from
Paediatric Nephrology OPD- 20(4.5%)

Obstructive Uropathy (PUJO,PUV,HDN) 14

VUR-G-V 01
Hypospadius 01
Phimosis 03

Neurogenic Bladder 01
Patients referred to Paediatric Urology Dept
from Paediatric Nephrology Dept

20

Paedi Nephro
Paedi Uro

442
 Death review
No. Name Sex Age D/A Dx Cause of death
D/D
1 Tanzina F 9y 10.08.23 CKD(St-5)with HTN HF
(12:00pm) with HF
02.10.23
(8:25pm)
H/S-54d
 Case Summary
• Tanzina,9y old female child,5th issue of her
non-consanguinous parents, hailing from
Kishoreganj got admitted with the C/O,
generalized weaknesss for 1m & respiratory
distress for 10days.She had no H/O
haematuria ,joint pain ,rash or, convulsion.
 Contd…..
• During admision ,
she was semi-conscious ,severely pallor,
oedematous, cyanosed with gasping respiration.
Regarding vitals-Temp-99F , P-feeble,
H/R-144b/min, R/R-24/min,BP-80/40mm of Hg
(SBP &DBP both<50th centile) SpO2-74%(without
O2),BSUA+++ Ascites was present. L-crep+
• Initially Dx: CKD(St-5)with severe anaemia with
metabolic acidosis with heart failure with shock.
• Initial Mx:
O2 inhalation(5L/min)
Inf.Normal Saline
Inj.Meropenam
Inj.Frusemide
Inj.Sodi-Bi-Carb
BT
 Contd….
• After treatment, patient’s acidotic breathing &
heart failure was improved. We started HD
through femoral catheter. By this time she
developed HTN which was initially
uncontrolled, later controllled with five anti
hypertensives. She was on maintainance HD &
became a bit stable ,we counselled for A-V
fistula, but due to financial constrain they
couldn’t proceed further.
 Contd…
• Due to patient’s long stay & irregular fever,we
used-
Inj.Meropenam
Inj.Ciprofloxacine
Inj.Ceftazidime
Inj.Flucloxacillin
Inj.Vancomycin
Inj.Ceftriaxone
 Contd..
• Lastly she got date for A-V fistula from
Vascular Surgery dept, NICVD.All relevant inv
(BT,CT,PT,APTT,ECG,Echo)were done. But
couldn’t do fistula.
• She was on maintainance HD, but again
developed HF & this time with Inj. Frusemide,
Inj. Digoxin –we couldn’t revive her. So, she
was declared dead on 02.10.23 at 8:25pm.
 Investigations:
• CBC:
09.08.23 13-08-23 20.08.23 12.09.23 25.09.23

Hb-7.1 9.3 11.2 14.1 13.7

TC-19,290 11,000 9,470 6,800 9,390

Plt-3,88,000
3,20,000 2,32,000 1,36,000 1,68,000

ESR-35 35 15 20 20
 Contd…
CRP:
12.09.23 25.09.23
65 6.3

Urine R/E,C/S:
Urine R/E 02.08.23 12.09.23 26.09.23

Pus 10-15 1-2 1-2

RBC 2-3 Nil Nil
Protein ++ ++ +++
 Contd….
• S.Electrolytes:
16.08.23 22.08.23 30.08.23 25.09.23
Na+ 137 133 137 140

K+ 2.5 3.6 3.5 5

Cl- 95 100 103 100

HCO3- 20 24 23 27
 Contd…
• S.Creatinine&Urea:
09.08 10.08 13.08 16.08 24.08 27.08 11.09 20.09 26.09 28.09

S.Cr 8.3 7.8 5 4.4 4.9 5.1 3.3 6.3 3.7 3.5

Urea 308 160 89 151 121 60

 Contd..
• S.Albumin-2.3g/dl
• S.Cholesterol-227mg/d
• S.Calcium-5.76mg/dl
• ANA-negative
• S.C3 & S.C4-Normal
• USG of KUB-B/L renal parenchymal disease
Mild ascites
Lt-5.5cm,Rt-6.4cm
I/V correction for hypokalemia & hypocalcemia was given.
Thank You All