37y/M

37y/M farmer by occupation, resident of Nalgonda 

c/o breathlessness since 1 month 

C/o of cough 1 month ago

C/o facial puffiness since 1 month 

C/o of on and off episodes of Pedal Edema since 1 month. 

History of Present illness : 

Patient was apparently asymptomatic 1 month back, later he developed 

• SOB since 1 month 

           - Grade -2 ~>3 

           - insidious in onset, gradual in progression

• Facial puffiness since 1 month 

• Pedal Edema -  Pitting type 

                            - Grade 2

             - on and off episodes (after 3rd Dialysis)

   ° cough - insidious onset, gradual progression 

                   - with reddish expectoration

                    

    Patient was taken to a local private hospital in Nalgonda where he was diagnosed with CKD on MHD with HTN with Anemia 2° to renal failure and was started with dialysis. 

    During his stay, he was diagnosed with hypertension de novo. For which he was using Tab.Nicardia 20mg  PO/TID anf Tab.Arkamine 0.1mg PO/OD. 

    He underwent 6 dialysis, the last dialysis dates on 17/11/21.  All his complaints subsided gradually on dialysis. 

    17/11/21 : Cr: 3.7, Urea:40, Hb : 7.9 

   - He was then brought to our OPD as they weren't able to afford the expenses. 

He was an occasional alcoholic. 

Not a k/c/o diabetes, CAD, Asthma, Epilepsy 

No significant family history. 

O/E : 

Temperature : Afebrile 

PR : 88 BPM

RR : 22 CPM

BP: 150/80 mm of Hg. 

Sp02 : 99% at RA. 

Systemic examination : 

CVS : S1,S2 + 

RS : BAE +, NVBS 

CNS : NAD

Clinical images : 

Investigations : 

1. USG:  

 

2. Hemogram : 

3. CUE :

4. RFT 

5.ECG

6. 2D ECHO

Treatment:  

One session of Dialysis done on 24/11/21

1. Fluid restriction < 1.5L/Day 

2. Salt restriction < 2.5g/Day 

3. T. Nicardia 20 mg PO/TID

4. T. ARKAMINE 0.1 MG PO/TID 

5.  T. LASIX 40MG PO/BD 

6. T. SHELCAL-CT PO/OD 

7. T. OROFER XT PO/ OD

8. T.PANTOP 40 MG PO/OD 

9. INJ. ERYTHROPOETIN 4000 IU S/C WEEKLY ONCE.