CHRONIC KIDNEY DISEASE CASE

   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 .

FAMILY HISTORY:

No relevant family history .

 *PERSONAL HISTORY : 
 
DIET :mixed 
APPETITE:Normal 
SLEEP: Inadequate 
BOWEL AND BLADDER : Decreased urine output (abnormal)and normal bowel 
ADDICTIONS: Tobacco chewing and drinks alcohol occasionally 

GENERAL EXAMINATION:

Patient is conscious, coherent and co operative and the patient is moderately built and moderately  nourished
: PALLOR: +

*NO EVIDENCE OF ICTERUS CLUBBING LYMPHADENOPATHY 

*BILATERAL PITTING PEDAL EDEMA

*VITALS :

*TEMPERATURE:Afebrile 

*BP :110/60 mmHg 

*PULSE RATE :70 bpm

*RESPIRATORY RATE :15 breaths per min

 *SYSTEMATIC EXAMINATION:

*CVS :S1 and S2 heard and no murmors 

*RS : 
•Dsypnoea: +
•wheeze:  -
•Trachea : centrally placed 
•chest is normal 

*ABDOMEN : 

∆Shape of abdomen: scaphoid 
∆Tenderness : No 
∆palpable mass : No 
∆Liver : Not palpable 
∆Spleen : Not palpable


*CNS : No focal neurological deficit.
       
         Clinical images:











   ## INVESTIGATIONS##

*COMPLETE BLOOD PICTURE* 

*Hb: 6.7 gm/dl

*TLC: 7100 cells/cumm

* Neutrophils: 82%

*Lymphocytes: 10%

* Eosinophils: 4%

*Monocytes: 4%

* Basophils: 0%

* PLC: 2.26 lakhs/cumm

*NORMOCYTIC NORMOCHROMIC ANEMIA WITH RELATIVE NEUTROPHILIA

* RBS: 160 mg/dl

*SERUM ELECTROLYTES*

* Na: 136 mEq/L

*K: 4.8 mEq/L

*Cl: 96 mEq/L


*SERUM CREATININE* 

*Serum Creatinine: 5.1 mg/dl


*BLOOD UREA*

Blood Urea: 112 mg/dl

*ECG*


*USG *

USG SHOWS BILATERAL PEDAL EDEMA GRADE 2.

*PROVISIONAL DIAGNOSIS : 

CHRONIC KIDNEY DISEASE WITH MAINTAINENCE OF HAEMODIALYSIS.

* TREATMENT : 
 
•Dialysis and supportive care.
•Salt restriction < 2gm/day
• Fluid restriction < 1.5 L/day


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