What is your diagnosis and plan of treatment for this case | Figure 1

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Medical Resident | Nephrology

Posted Anonymously

What is your diagnosis and plan of treatment for this case

44y female with history of gall bladder stones. She presented to ER by rt hypochonderial pain referred to rt shoulder. She was given 60mg im declofenac sodium and discharged on ibuprofen 600mg/6h. She took ibuprofen 3times/day for six days.

She developed epigastric pain and diminished her appetite, so she decreased ibuprofen to twice /day and added ppi and acetaminophen. Her rt hypochonderial pain improved. She developed new lt sided loin pain with passage of cloudy dark urine for which she came to ER.

Bp 150/95

Temp 36.6c, lt renal angle tenderness

Cr 3.9, Na 135, K 5.8

Tbilirubin 3mg/dl (direct 2.5), Alp 250

Ast Alt high normal

Cbc normal

Crp 22

Xrays UT normal

Pleviabdominal us shows a filling defect in left plevicalcyeal system with mild hydronephrosis on left side.

Urine culture: No growth