40year old with CKD

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CHEIF COMPLAINTS:

A 40yr old male came to the hospital with cheif c/o SOB and pedal  oedema since 3 months.

Patient has come maintainance haemodialysis.

HOPI:

Patient was apparently asymptomatic 3months back then he developed pedal edema(upto knees) which was insidous  in onset , gradually progressive , no aggravating and relieving factors,which was of pitting type .

On Dussehra(15/10/21) patient suddenly developed SOB (grade-4) and admitted in our hospital and 1st dialysis was done on Dussehra.

Diagnosed as CRF with ANEMIA .

Dialysis initiated on 15/10/2021.

4 sessions of HD done.

20 PRBC Transfused.

PAST HISTORY:

Not a k/c/o HTN,DM,TB,Asthma , CAD,CVD.

No past surgical history .

H/o 2 blood transfusions since Dussehra.

Family history insignificant

PERSONAL HISTORY:

Patient's appetite & sleep decreased .bowel movements are normal and c/o decreased urine output .

He is a farmer by occupation and patient is not going to work since 6months.He is having 3 daughters and they work as daily wage labourer.

He used to consume alcohol occasionally 5yrs back .At present he is not consuming alcohol.No H/o smokking, tobacco chewing ,betel nut chewing.

There is no H/o admission in outside hospital or any medication usage from RMP

O/E 

Patie t is C/C/C moderately built and nourished

Pallor+

No icterus,cyanosis,clubbing,lymphadenopathy

oedema of legs+

VITALS: 

Afebrile.  Pr-96.    Bp-130/90.    Rr-17cpm.   Spo2-97%Ra

SYSTEMIC EXAMINATION

Cvs: bilaterally symmetric chest wall .no precordial bulge .no thrills and no murmurs.

S1& S2 heard.

Respiratory system: no dyspnoea, no wheeze

Position of trachea- central, no adventious sounds heard

CNS: patient is normal and concious .reflexs are normal.

INVESTIGATIONS:

1)USG- B/L  grade 3 RPD 

B/L sole renal cortical cyst

2)serum creatinine- 8mg/dl

3)Blood urea-160 mg/dl

Treatment

Fluid restriction (<1l/day)

Salt restriction (<2g/day)

T· LASIX 40 mg PO BD

T. Nicardia 10mg PO BD

T. NODOSIS 500 MG PO BD

T. OROFER-XT PO BD

Inj.ERYTHROMYCIN 4000IU /sc weekly once

Inj. IRON SUCROSE 100 MG IN 100 ML NS DURING DIALYSIS

DIAGNOSIS: CKD on MHD