50 year old female with Chronic Kidney disease on Maintenance Hemodialysis

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CASE DETAILS ::

This is a case of a 50YR old female patient who hails from a rural area of nalgonda district..

She came to the OPD with the chief complaints of 

* BILATERAL PEDAL EDEMA since 20 days

* SHORTNESS OF BREATH since 5 months

HOPI :

Patient was apparently asymptomatic 6 months back She developed shortness of breath Grade III- IV

She then developed bilateral pedal edema which is of pitting type , gradually progressive

She visited a hospital at Suryapet where she was found out to have high creatinine level and has referred to KIMS, Narketpally for Dialysis

No history of decreased urine output, fever , cough , burning micturition 

PAST HISTORY ::

There were no similar complaints in the past. 

Patient is a known case of hypertension since 1 year (on regular medication)

Not a known case of DM , asthma , Tuberculosis, CAD , epilepsy.

NO history of previous blood transfusion.

NO history of previous surgeries.

PERSONAL HISTORY :

Mixed diet with normal appetite

Bowel movements regular

No addictions.

No known drug or food allergies.

GENERAL EXAMINATION ::

Patient is conscious, coherent and cooperative.

She is moderately built and nourished.

Pallor - PRESENT

Icterus - absent 

Clubbing - absent 

Cyanosis- absent 

Lymphadenopathy - absent 

Edema - PRESENT ( BILATERAL PEDAL EDEMA).

VITALS ::

Temp. : Afebrile.

Pulse rate : 84 bpm 

Respiratory rate : 22 per min.

B.P : 140/90 mm of Hg.

spO2 : 94% at room air.

On examination of lower limbs , the pitting type of edema was elicited over the dorsum of both foot.

https://youtu.be/8xgOI7Lwb0U

SYSTEMIC EXAMINATION ::

Respiratory system:

Normal vesicular breath sounds heard.

CVS :

S1 , S2 heard , no murmurs.

CNS : 

No sensory and motor abnormalities.

Per abdomen :

Soft and non tender , no organomegaly.

INVESTIGATIONS :

PROVISIONAL DIAGNOSIS :

CHRONIC KIDNEY DISEASE on MAINTENANCE HEMODIALYSIS 

with Bilateral Pleural effusion

Known case of hypertension since 1 year

TREATMENT :

Weekly 2 sessions of Dialysis are being done

Fluid restriction ( less than 1.5litre per day)

Salt restriction ( less than 2gm per day )

Tab. Nicardia 20mg × po × BD.

Tab. Lasix 40mg × po × BD

Tab. Orofer × BD

Tab. Nodosis 500mg × po× BD

Tab SHELCAL PO / OD

Blood transfusion was done on 13/12/2021 for treating co-existing anemia.