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Opinion of DERMATOLOGIST for change on areola.

Resolved Question:

I have the change on right areola can get the opinion of a dermatologist i am 42 year old man.


Category: Pediatrician

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Category: ICU/ Critical Care Specialist
Dr. Saptharishi L G is online now

Expert:  Dr. Saptharishi L G replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
I can understand your situation. Your daughter's problems are definitely a source of concern.
Her underlying diagnosis appears to be CHRONIC KIDNEY DISEASE secondary to vesicle-ureteric reflux. Such children are at risk for development of UTI (urinary tract infections) due to alterations in urodynamics. But, your mention of a 'big' infection in May and her not being well ever since does not sound okay to me...
1. What was the urine culture report at that time? Did she receive adequate dose and duration of appropriate antibiotics? If yes, why does she continue to be unwell?
2. Her being tired and going for a 'wee' all the time also sounds suspicious. Is she having POLYURIA? Abnormal increase in urine output? Does she have an underlying tubular dysfunction? Does she also have excessive thirst or hunger?
3. Is she gaining height and weight normally for her age? What is her current height and weight?
4. If she was indeed treated adequately for her urinary tract infection, why is her urine examination still showing 70 leukocytes? That would mean that she continues to harbour an infection.. When was the last urine culture test performed? What was the result?
5. Her urine ketone positivity also is definitely abnormal? Ketones in urine can occur because of starvation or drugs also.. Is she also on any other medication like diuretics, oral bicarbonate, etc.. How did you test her urine ketones? Was it based on a dipstick or laboratory assessment?
6. Has she been tested for diabetes? Does her urine show glucose positivity? Does she have documented hyperglycemia till date? It would be better to undergo a formal testing for diabetes mellitus in this case..
7. What are her last urea, blood urea nitrogen, creatinine values? What is the last calcium, phosphate, hemoglobin and blood gas analysis report?
Regards
Dr. Saptharishi L G


Dr. Saptharishi L G
Category: ICU/ Critical Care Specialist
Experience: 
Senior Residency: DM,  Pediatric Critical Care, PGIMER

Residency: MD, Pediatrics, Postgraduate Medical Education & Research (PGIMER), Chandigarh, 2013

Internship: JIPMER, 2009

Medical School: MBBS, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, 2008
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