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CHRONIC KIDNEY DISEASE CASE

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   A 65 year old woman resident of Nalgonda farmer by occupation with known history of Chronic renal failure came to the hospital for maintenance of haemodialysis .                             CHIEF COMPLAINTS  :   *PEDAL EDEMA from past 3 months  *Fever , shortness of breath from 10 days  *Decreased hearing from 10 days                               HOPI: Patient was apparently asymptomatic 3 months back then she developed bilateral pedal edema which is gradual in onset, slowly progressive and is of pitting type (extended upto the thigh) associated with facial puffiness , then she developed* fever (low grade and is relieved on medication),*shortness of breath (Grade 3) , with *decreased urine output 10 days back. PAST HISTORY: Patient is known case of Chronic renal failure :6 years back.  *Haemodialysis done for 4 times from the time she developed CKD and then she stopped her  regular maintenance of dialysis . *She is a known case of hypertension for which she is on anti hypertensives