A 55 yr old male patient came with loin pain,fever and severe itching of skin all over the body

General medicine 
Hi i am Ishan More 3rd sem This is an online E logbook to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through a series of inputs from the available global online community of experts intending to solve those patients' clinical problems with collective current best evidence-based inputs

Chief complaints:
A 55 year old male patient came to OPD with chief complaints of Loin pain since 3 months 
Severe itching of skin all over the body since 3 months
Fever since 5 days

History of present illness :
Patient was asymptomatic 3 months before then he developed with loin pain radiating towards back of the neck and severe itching of skin all over the body which appears as white spots
Fever from 5 days back and now shortness of breath from last 5 days

History of past illness:
He has a history of diabetes mellitus from 2 years back and hypertension from 1 month 
No H/O asthama,TB, epilepsy

Personal history:
Married
Mix diet
Appetite normal
Regular Bowel movement
Frequent urination
No allergies
No habits of any alcohol or smoking

Family history :
H/o asthama to his father

General examination:
Conscious and cooperative 
Coherent
No pallor
No icterus
No cyanosis
No lymphadenopathy 
No Pedal edema

Vitals-
Temp: 95.9⁰F
BP: 130/70 mm of Hg
Pulse: 69bpm
RR: 16cpm
SpO2: 100% at room temp
GRBS: 121 mg/dl

SYSTEMIC EXAMINATION :
CVS:
Cardiac sounds: S1 and S2
No thrills
No cardiac murmurs

RESPIRATORY SYSTEM:
No dyspnea
No wheeze
Central location of trachea
Vesicular breath sounds

ABDOMEN-
Abdomen is obese
No tenderness
No palpable mass
Non palpable liver and spleen
Bowel sounds are not heard

CENTRAL NERVOUS SYSTEM 
Conscious 
Speech- normal
Signs of meningeal irritation - 
no neck stiffness
no kerming's sign
Cranial system - intact 
Motor system - intact 
Sensory system - intact 
 Cerebeilar signs
    Finger nose- in coordination
    Knee heel - in coordination

Provisional Diagnosis:
Chronic renal failure,
Hypertension,
Diabetes mellitus

Investigation:
Hemogram,CBP,serum creatinine,Blood urea, ultrasound,2D echo,ECG,serum electrolyte
Treatment:
Hemodialysis
Blood transfusion

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