32 YEAR OLD MALE WITH CKD ON

 

32 YEAR OLD MALE WITH CKD ON MHD

32 years old male patient came with chief complaints of shortness of breath and pedal edema since 1 year.
History of present illness:
Patient was apparently asymptomatic 1 year back then developed:
1)Shortness of breath which is insidious in onset,gradually progressive, NYHA grade 2, aggravated on exertion and relieved with rest.
2)Bilateral pitting type of pedal edema extending upto ankles,aggravated on walking, relieved on lying down.
History of decreased urine output. 
History of facial puffiness more during daytime.
History of jaundice 1 year back.(History of usage of herbal medication for jaundice).
No history of chest pain/palpitations.
No history of chronic cough/hemoptysis

Patient went to NIMS hospital with the above mentioned complaints.
His RFT was deranged and renal biopsy showed glomerular basement membrane thickening and focal effacement of visceral epithelial foot processes.
Dialysis was initiated from then and he is getting weekly 3 dialysis sessions.
Past history:
He is a known case of hypertension since 5 years and was on Telmisartan 40 mg initially and is now on Nicardia 10 mg since 1 year.
Not a known case of DM,epilepsy,asthma,
TB,CAD,CVA.
Personal history:
Diet-mixed 
Appetite-decreased
Bowel and bladder movements-regular
Daily alcohol consumer 5 years back,stopped 5 years back
General examination:
Patient is conscious, coherent, cooperative .
Pallor +
No icterus,cyanosis,clubbing,
lymphadenopathy.
Bilateral pitting type of edema present extending upto the level of ankles. (depression of 2 mm noted,rebounding immediately)











Vitals:
PR-90 bpm
RR-18 cpm
BP-140/90 mm Hg
SpO2-98% @ RA
GRBS-126 mg%
Systemic examination:
CVS-S1,S2 heard,no murmurs. 
RS-BAE present, 
CNS-NAD
P/A-soft,non-tender,bowel sounds+
Investigations(2/11/21):
 
Investigations (3/12/21):










Provisional diagnosis:
CKD on maintenance hemodialysis.
Treatment:
Fluid restriction (<1L/day)
Salt restriction (<2g/day)
T.NICARDIA 10 MG PO/TID
T.LASIX 40 MG PO/BD
T.MVT PO/OD
INJ.ERYTHROPOIETIN WEEKLY ONCE

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