A 65 year old female CKD Patient on Maintenance Hemodialysis

 A 65 year old female, a resident from nalgonda,farmer by occupation, with known history of Chronic Renal failure, came to hospital for Maintenance Hemodialysis and for medical checkup

C/O: 
        Pedal edema from past 3months,
        Shortness of breath from past 7 days,
        Decreased hearing from past 7 days,
        Fever
H/O Present Illness:
                                          Patient was apparently asymptomatic 3months back,then she developed bilateral pedal edema (Pitting type extending upto thigh) which was gradual on onset,slowly progressive and also with facial puffiness associated with shortness of breath(Grade 3)(have to stop for breath when walking at own pace) from past 7 days and with decreased urine output from past 7 days later she came to know that these irregularities maybe due to failure of her followup on regular treatment, then patient came to hospital for further management
Past History:
                               Patient is an known case of Chronic Renal failure 6years back; and Hemodialysis done for 4 times from the time she developed CKD...and then she stopped her regular maintenance hemodialysis
patient is an Hypertensive for which she is on regular medication
Personal History:
                              Appetite: Normal
                             Diet: Mixed
                             Sleep: Inadequate
                            Bowel and Bladder: Irregular(decreased urine output)
                           No known Allergies
                           Habits: Occasional chewing of Tobacco;
                                       Occasional Alcohol consumption
Family History: Familial history of Hypertension and Diabetes

GENERAL EXAMINATION:
                                                    Patient is Conscious;Coherent;Co-operative and well nourished 
                                            Vitals:
                                                       Temp:98F
                                                      PR:72bpm
                                                      RR:20/min
                                                      BP:110/70mm/hg

Pallor (present)

and theres no evidence of signs of Icterus;Clubbing;Lymphadenopathy;
Edema (B/L Pitting)
SYSTEMIC EXAMINATION:                          
                                                                            
CVS:
S1;S2 heard,
no murmers
RS:
Dyspnoea-No
No wheeze
Trachea-Central
Breath sounds-Vesicular
ABDOMEN:
Scaphoid;not tender;with no palpable masses;no free fluid;no bruits
CNS:
Functions are Intact and No abnormalities detected
PROVISIONAL DIAGNOSIS:
CKD on MHD
INVESTIGATIONS:
1)Complete Blood Picture:

2)Serum Electrolytes:
   

3)Serum Creatinine:

4)Blood Urea:
5)Ultrasound Report:
USG findings shows:
                                  B/L Grade 2 Renal Parenchymal Disease
Treatment:
                   Dialysis and Supportive care







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