Long case : 67 year old female patient with CKD
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Chief complaint:
A 67 years old female with chief complaint of :
* Shortness of breath since - 3 months
*Pedal edema since -3 months
* Decreased urine output since 3 months.
History of present illness:
Patient was apparently asymptomatic 1yr back then she noticed decreased urine output and then she was diagnosed by heart failure and renal failure started medication.
Then 3months back she noticed increased Bilateral pedal edema -pitting type, extending till ankles
shortness of breath - gradually progressing from grade 2 to grade 3 and which is subsided now.
Slight burning during micturition
No history of PND,Cough,Cold,Fever
History of past illness:
K/C/O Hypertension since 30 years, diabetes mellitus since 30 years
Not known case of asthma, tuberculosis, epilepsy.
Treatment history:
For hypertension tab arkamine,Nicardia
For Diabeties Mellitus: Tab Glimy 3Mg/PO/BD
Personal History:
Diet - Mixed
Appetite - Lost
Bowel - constipation
Bladder movement - Irregular
Sleep - Adequate
Micturition - slight burning
No addiction
Family History:
No known member of the family has similar Complaints
General Examination:
Patient is conscious, coherent,co-operative
No cyanosis, icterus, lymphadenopathy, clubbing of fingers.
. 
Vitals : -
Temperature - Afebrile
Bp - 160/100
Pulse rate - 100/min
Respiratory rate - 16 cycles / min.
Systemic Examination:
Respiratory system :
Inspection : -
Chest is
bilaterally symmetrical
Movements are bilaterally symmetrical.
Position of trachea Is central
No Sinuses,Scars,Fistulas
Palpation :
ALL INSPECTORY FINDINGS ARE CONFIRMED BY PALPATION.
Local rise in temperature: No
Non tender
Apex beat felt in 5th intercostal space 2cm lateral to midclavicular line .
Percussion:
Resonant sound is heard
Auscultation:
Normal vesicular sounds are heard.
Cvs:
Inspection :
Bilaterally symmetrical chest
No visible engorged veins,scars or sinuses on chest.
Palpation :
S1 S2 are heard
No thrills , no murmurs
Apex beat present at 5th intercostal space 2cm lateral to midclavicular line .
Auscultation :
Cardiac rate - 100 beats per minute
No cardiac murmurs heard.
Abdomen :
Inspection:-
Shape of the abdomen - distended
Flanks- full
Umbilicus - central and inverted
Sinuses and scars - not visible
No dilated veins
Palpation :-
No local rise in temperature
No tenderness
No palpable mass
No organomegaly
Hernial orifice -normal
Free fluid - yes
No bruits
Liver not palpable
Spleen not palpable
Percussion:-
Shifting dullness positive
Auscultation:-
Bowel sounds heard
CNS:
Conscious, speech is normal
No neck stiffness
Kernings sign - negative
No finger and nose in coordination.
Provisional diagnosis: - Chronic renal failure
Anemia
Resolved heart failure
Investigations:
USG ABDOMEN:
2D echo:
Complete blood picture:
Complete urine examination:
Random blood sugar:
Serum creatinine :
Serum electrolytes:
ECG:
Management:- Hemodialysis
Inj frusemide-40 mg/Iv/Tid
Tab:Nicardia-10 mg/Po/Tid
Tab Nodosis 500 mg/Po/Tid
Tab shelcal-500 mg/Po/OD
Inj.pan-50 mg/iv/OD
Tab orofer-Po/OD
Cap BioN-Po/OD
Inj Erythropoietin-4000iu weekly once
Inj iron sucrose-1000 mg/iv in 100 ml NS weekly once
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