9 yrs old male with renal calculi

 NOTE: 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 CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT. 

PATIENT HISTORY: Pt is a 9 yr old male.

On third day post delivery suffered from neonatal jaundice.

At the age of 7months, the infant was having trouble in sucking milk from breasts. He was taken to Dr. and symptoms resolved within days with medication.

When he was 2.5 yrs, he suffered from diarrhea, vomiting. Was admitted to hospital, discharged next day. He recovered within 2 days.

When he was 6.5 yrs old, he c/o dry cough, reduced appetite, malaise. His mom noted his stool has a characteristic acidic smell. Defecation once daily, normal color and semisolid consistency. His dry cough would reappear during seasonal variation and gradually would get worse. Dr. suggested using an inhaler which caused some relief. Then 2 months homeopathy treatment was done, after which he never complained of dry cough. But, sometimes till date his mom notices his stool has a characteristic acidic smell.

When he was 8 yrs old, one day he c/o nausea, reduced appetite. Dr. prescribed medicines to aid digestion, which gave some relief. So, again taken to Dr.'s chamber where he vomited. Inj was pushed to treat his symptoms and USG was recommended. USG revealed a stone 3.3 mm in rt. kidney. Pt started c/o nausea, acidity, malaise and stomach discomfort. He was prescribed Kmac B6 active and advised to drink alteast 3 lts water. His stone size reduced to 3 mm after 3 months. 

Thinking he is recovering well and would take him to Hyd for further consultation, they stopped giving hi, medication and all diet restrictions were lifted (started eating excess amount of chicken, milk and reduced daily water intake). After acting like this for a month, repeat USG was done which detected a stone of 3.9 mm. Immediately taken to Dr. who changed medication to Magstone B6 syrup b.d, which he is taking for the past 3 wks.

CHIEF COMPLAINT AND PT REQ: stone in rt kidney detected on Oct 2021

FAMILY HISTORY: Grandfather - gallbladder stone, DM, CKD

Mother - 2-3 yrs ago, one night while sleeping c/o palpitation, excess seating, general body weakness. She was given salt sugar water, drinking which she felt much better. Few months later, once while returning from market she felt lightheaded, her whole body felt extremely weak, hard to move. Somehow she reached home. Dr. prescribed medications which she took for 1-1.5 months, after which she felt better. But since that incident never travels alone. 

She claims during that time, she was unable to take proper care for her kid. Hence, pt did not have a balanced diet at that time (only boiled potato, rice mostly).

REPORTS: 

PROVISIONAL DIAGNOSIS: rt renal calculi