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A 45 year old female patient came with chief complaints of fever and vomitings since 10 days

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 A 45 year old female patient Homemaker by occupation came with chief complaints of fever and vomitings, decreased urinary output since 10 days  HOPI  Patient was apparently asymptomatic 1 yr back. Then she developed vomiting, pedal edema and decrease urine output since 1 week .They went to the hospital and was diagnosed with kidney disease and she had 2 dialysis sessions . Now again after 1yr from 10 days she developed vomiting and fever and decreased urinary output. Vomiting was non projectile and non blood tinged .Fever was associated with chills and rigor and increased during night time. Patients daily routine Patient is a homemaker and daily gets up in the morning and does house hold work.Before 4 yrs she worked as a agricultural labourer   past history No history of DM,HTN, thyroid disorders, Tuberculosis,Asthma  Family history No significant family history  Personal history Diet:mixed  Appetite: Decreased Bowel and bladder : Regular Addictions:No addictions  General examination