CKD

 A 48 year old male, R/O mothkur, labourer by occupation came to OPD 

C/o : 

1. generalised swelling of the body since 20 days
2. Chest pain since 10 days

Sequence of events : 

30 December 2021 : 

Swelling of hands, feet and face 

Shortness of breath at rest 

Urine - fast stream, followed by dribbling 

19 January 2022 : 

Chest pain, 

Shortness of breath at rest 

Swelling of hands, feet and face 

26 January 2022 : 

Altered sensorium 

Difficulty in speech

Hopi : 

Patient was apparently asymptomatic 1 month back, when he developed

• generalised edema, insidious onset and progressive for which he consulted doctor
• He was advice to get dialysis done. 
• Patient didn't get dialysis and went home with medicine 

 After medication the swelling reduced, but didn't disappear. 

• Patient came back again on 19 Jan with chest pain sudden onset, following spicy meal, squeezing type, no radiation. 
• Generalised swelling of the whole body which started in the legs and spread to whole body. 
• Swelling insidious in onset and progressive 
• Shortness of breath grade 4 
• No associated fever, cough, vomitings, burning micturition or Oliguria 
• 5 days ago patient developed difficulty in talking and Altered sensorium 

Past history : 

• Patient diagnosed with hypertension in 2018, irregular use of medication. 
• No h/o diabetes, asthma, TB, epilepsy 
• No h/o past surgeries 
• H/o blood transfusions 

Personal history : 

Diet - mixed 

Apetite - normal 

Bowel/bladder - regular 

Sleep - adequate 

Addictions - consumes alcohol regularly

                       Chews tobacco regularly 

No Allergies 

Family history : 

No h/o kidney disease in family 

General examination : 

Patient is conscious, coherent, cooperative. 

Moderate built and nourished

Pallor present 

No signs of Icterus, clubbing, Cyanosis, Lymphadenopathy

Vitals : 

Temperature - afebrile 

Pulse rate - 80bpm

Respiratory rate - 20cpm

Blood pressure -120/80mmhg

Abdominal examination : 

INSPECTION : 

• Shape of abdomen - distended 
• Umbilicus - slit like
• Movements - equal in all quadrants 
• No scars, sinuses, visible pulsations

PALPATION : 

• Movements - equal in all quadrants 
• Fluid thrill present 

PERCUSSION : 

• Dull note on Percussion 

AUSCULTATION : 

• Bowel sounds present 

Respiratory examination : 

Bilateral air entry present 

Normal vesicular breath sounds 

CNS examination : 

GCS - 

Sensory and motor system normal

Cranial nerve examination normal 

CVS examination : 

S1 and s2 heard, no murmurs 

Investigations : 

Hemogram 

On 20 jan

On 21 Jan 

On 31 Jan 

Liver function tests : 

On 21 Jan 

On 29 Jan 

Renal function tests : 

On 29 Jan 

On 21 Jan 

Serum iron : 

Serum creatinine : 

Ecg : 

Diagnosis :  Chronic kidney disease on MHD

Treatment : 

• Tab pantop 40 mg I. V. OD 
• Tab Lasix 40 mg peroral BD
• Tab orofer OD
• Tab nodosis 500mg BD 
• Tab shelcal OD
• Tab multivitamin OD
• Monitor vitals 
• Tab nicardia 20 mg peroral BD