CKD

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 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 




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