1601006091 SHORT CASE
A 35 YEAR OLD GENTLEMAN WITH CHRONIC KIDNEY DISEASE
Treatment:-
A 35-year old gentleman who is a farmer by occupation, resident of Miryalaguda ,came to the hospital with:
Chief complaints:-patient came to the hospital with chief complaints of swelling in both the legs since 13 months.
History of presenting illness:-
Patient was apparently asymptomatic 3 years back when he was incidentally diagnosed with raised blood pressure of 200/110mmhg for which he was put on medication, which he took for 4 months but wasn’t compliant and stopped taking them thereafter and was asymptomatic for 7 months since then.
Patient started developing bilateral pedal edema since 13 months, insidious in onset, pitting type, extending up until knee, associated with mild facial puffiness and decreased urine output since one year for which he came to the hospital and was put on maintainence hemodialysis for 10 months now.
Patient complains of abdominal distension and swelling of legs in between dialysis sessions.
No history of blood in urine.
No history of burning micturition.
No history of nocturia.
No history of fatigue, drowsiness.
No complaints of pruritis.
No history of altered sensorium.
Past history:-
Patient is a known case of hypertension for 3 years now.
Not a known case of diabetes mellitus, bronchial asthma, cardiac diseases, epilepsy.
No past surgical history.
Family history:-
no similar complaints in family, no history ofdiabetes,hypertension,asthma,cardiovascular conditions.
Personal history:-
Mixed diet ; decreased appetite; sleep is adequate.
Bowel and bladder habits are normal.
Occasional alcoholic; not a smoker.
General Examination:-
Patient is conscious ,coherent ,cooperative, moderately built and moderately nourished.
Pallor present evident in lower palpebral conjunctiva and pale tongue.
No icterus, no cyanosis, no clubbing, no koilonychia, no generalised lymphadenopathy ,bilateral pedal edema facial and periorbital puffiness seen
Vitals :-pulse taken in sitting position, left radial pulse; pulse rate :- 90 bpm.
Blood pressure:- 140/90 mmhg measured in sitting position on left upper arm,
Respiratory rate:- 20 cpm.
Elevated jvp at 45 degrees.
Afebrile.
Abdominal examination:-
Inspection: Abdomen is mildly distended.
On palpation:- soft and non tender.
Shifting dullness is present.
Fluid thrill is absent.
Suggestive of moderate ascites.
Bowel sounds heard.
CVS examination:- s1, s2 heard , no murmurs, Hyperdynamic apex is seen ,no palpable thrills.
CNS examination:-
Higher mental functions intact.
patient was alert and conscious.
No signs of meningeal irritation, normal gait and speech.
Pupils equal and reactive to light.
Reflexes:- Superficial and deep tendon reflexes are intact.
Provisional diagnosis:- Chronic kidney disease with secondary hypertension, with bipedal edma , ascites and anemia.
Investigations:-
The following tests have been done.
Complete blood picture
Urinalysis
Renal function tests
Liver function tests
Blood sugar, serum potassium
Chest x ray, ecg
Ultra sound abdomen.
Salt restricted diet (<2 gm/day)
Fluid restriction (< 1 L/day)
TAB. FUROSEMIDE 40 mg BD
TAB. SODIUM BICARBONATE 500 mg BD
TAB. NIFEDIPINE 10 mg TID
TAB. CLONIDINE 0.1 mg BD
TAB. CALCIUM AND VITAMIN D3 SUPPLEMENTS 500 mg OD
Maintenance Hemodialysis (MHD) .
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