Hi doctor, please help me about my babies treatment. Pataients history is attached here.
PATIENT’S PERSONAL HISTORY



Name of the patient : Tanassum Rahman

Age of the patient : 07 years and 3 months

Address of the patient : Rajshahi University, Bangladesh



Chief Complaints : 1. Right loin pain

2. High fever



Clinical

Review- Left kidney enlarged, palpable.



Investigation done- IVU- Non functioning left kidney (on 18-10-10)

USG of KUB- Severe HDUN-Left kidney (on 16-10-10)

DTPA Renogram- Right kidney 90%, Left kidney 9.87% (21-10-10)



Then patient is admitted to Comfort Nursing Home 02/10/10 and given Inj. Tineam and Suppositor under Prof. Dr. M.A. Salam, FCPS, FICS (Uro-oncologist).



Further Investigation done there- Urine R/E - Pus cells- 0-1/HPF (on 24/10/10)

Blood- Rendom plasma glucose 5.1 mmol/L (on 24.10.10)

Corresponding urine suger - Nill

Serum Creatinine 62 umol/L (on 24.10.10)

Serum Creatinine 65 umol/L (on 26.10.10)



USG of KUB- Left gross hydronephrosis.

PVR – 46cc



CT scan with contrast- Gross hydronephrotic changes in left

kidney probably due to PUJ obstruction (on 27/10/10).



Then diagnosed it a case of Left PUJO with pyonephrosis.

Then PCN (Percutaneous nephrostomy) done on 30.10.10 and after pus culture (growth of Pseudomonas sp (moderate)), continued Inj. Tineam for 05 days by Prof. M.A. Salam.



Then patient is discharged on 04/11/2010 with PN tube for 6 weeks and given treatment-

1. Cap. Denver- 1+1+1- 7 days

2. Tab. Rolac- 1+1+1- 5 days

3. Tab. Neotack- 1+0+1- 5 days

4. Tab. Filwel gold – 0+1+0- 1 month

After 6 days Tab. Fimoxiclave (375 mg) is given instead of Cap. Denver for 7 days (1+1+1).



On 28/11/10 DTPA Renal study done. Results- Right kidney 90%-Normal functioning. Left kidney 10%- Gross parenchymal insufficiency.



Present condition of the patient : Percutaneous nephrostomy tube is present.

Scanty micturation

A small amount of pus is coming with very little urine.

Infection is not cured completely.

No medicine has been taken now.

Fever absent from 10/10/2010.

Doctor has been extended the removal period of PN tube for another

8 weeks and then he wants to remove the left kidney if the kidney

function is not increased.



Please advice me what will I do. Could it possible to preserve the left kidney by any better treatment from you if available without removing the kidney of the patient? If you reply me with your kind opinion I will be ever grateful to you.