69 yr old male with Bilateral Hydroureteronephrosis

A 60 yr old male came to OPD with c/o pedal edema since 10 days
H/o poor stream urine +
H/o nocturia + 5-6 times
H/o increased frequency +  10-15 times
H/o urgency +

Patient was apparently asymptomatic 1 and half year back then he developed spontaneous pain and swelling in the right leg for which he was operated for the same ; no history of trauma to leg
Patient has history of NSAID abuse for 1 year due to severe leg pain

Past history : 
     N/k/c/o DM,HTN,ASTHMA,CAD, EPILEPSY

Family history :
    No significant family history

General examination :
   No pallor icterus cyanosis clubbing, lymphadenopathy

VITALS AT ADMISSION :
Temperature : AFEBRILE
PR: 82
SPO2:92
RR: 16
B.P. : 110/80

C.v.s: s1 s2 heard no murmurs
RS: BAE present
CNS: NAD

Diagnosis:
NSAID induced nephropathy

PLAN of treatment :

1. Fluid restriction (<2lit/day), salt restriction (<4gm/day)
2. INJ PAN 40 mg IV OD 
3. INJ ZOFER 4 mg IV OD
4. INJ PIPTAZ 2.5mg IV/TID 
5. TAB NODOSIS 500 mg po/ BD
6. Tab OROFER XT PO
 OD
7. Tab SHELCAL PO OD
8 Tab NODOSIS 500mg po/BD 

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