A 58 year old man with CKD

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This is a case of 58 year old male,agricultural labour by occupation came to OPD with chief complaints of shortness of breath since 15 days worsened 3 days back, facial puffiness since 1 week

History of Presenting illness - 

Patient was apparently asymptomatic 4 years ago

4 years ago - pt complained of giddiness, went to a local hospital and was diagnosed as Hypertensive, on regular medication since then T. Nicardia 10mg, T. Arkamine 0.1mg sos

2 years back Pt developed B/L pedal edema, progressed gradually to knees, diagnosed with renal failure and initiated dialysis weekly twice

Left upper limb swelling, gradually progressing to current size, since 4 months . Swelling in the left chest region, gradually progressing to current size, since 4 months

Back pain since 2 months, subsided on medication (T. Ultracet)

7 days back - developed Facial puffiness

Shortness of breath since 7days

Grade II-III progressed to Grade IV since 15 days along with orthopnea 

No c/o palpitations, giddiness, cold, cough, burning micturition.

PAST HISTORY -

Known case of Hypertension since 4years on Tab nifedipine 10mg OD

Not K/C/O TB, Epilepsy, Asthma, CAD.

PERSONAL HISTORY 

Appetite- normal

Diet- mixed

Bowel movement- Regular

Alcoholic stopped 4 yrs ago

Non smoker

ON EXAMINATION 

Pt is C/c/c

No Pallor,Icterus,Cyanosis, Lymphadenopathy

Edema of feet + 

VITALS

Pulse rate:94bpm

BP:140/90mm of Hg

SpO2:97% at RA

Temperature:afebrile

SYSTEMIC EXAMINATION:

CVS - S1,S2 +

RS - BAE + 

CNS - NAD

P/A- Soft, non tender

Investigations

USG REPORT:

ECG:

X RAY:

Serology - Negative for HIV,HCV,HBsAg

PROVISIONAL DIAGNOSIS :

CKD on MHD

TREATMENT 

Fluid restriction (<1l/day)

Salt restriction (<2g/day)

T· LASIX 40 mg PO BD

T. Nicardia 100mg PO BD

T. NODOSIS 500 MG PO BD

T. OROFER-XR PO OD

T. SHELCAL-CT PO OD