A CASE OF A 50YR OLD FEMALE PATIENT WITH CKD on MAINTENANCE HEMODIALYSIS , K/C/O HYPERTENSION SINCE 7YRS

 

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CASE DETAILS ::

This is a case of a 50YR old female patient who hails from a rural area of nalgonda district..

She came to the OPD with the chief complaints of 

* BILATERAL PEDAL EDEMA since 4 days 

* DECREASED URINE OUTPUT since 4 days.

* SHORTNESS OF BREATH since 4 days.

HOPI ::

Patient was alright 4 days back and performing her regular activities. Then she developed bilateral pedal edema which is of pitting type and involving feet and extending upto below knee level. Edema was gradually progressing and there were no aggravating and relieving factors.

She also complained of decreased urine output i. e, less than her normal urine output. She also experienced shortness of breath on the same day for which she was brought to the hospital.

There was no history of fever , cough , burning micturition 

PAST HISTORY ::

There were no similar complaints in the past. 

Patient is a known case of hypertension since 7 years for which she is on regular antihypertensive medication.

No DM , asthma , Tuberculosis, CAD , epilepsy.

NO history of previous blood transfusion.

NO history of previous surgeries.

PERSONAL HISTORY ::

Mixed diet with normal appetite

Bowel movements regular , decreased urine output.

No addictions.

No drug or food allergies.

GENERAL EXAMINATION ::

Patient is conscious, coherent and cooperative.

She is moderately built and nourished.

Pallor - PRESENT

Icterus - absent 

Clubbing - absent 

Cyanosis- absent 

Lymphadenopathy - absent 

Edema - PRESENT ( BILATERAL PEDAL EDEMA).

VITALS ::

Temp. : Afebrile.

Pulse rate : 84 bpm 

Respiratory rate : 22 per min.

B.P : 140/90 mm of Hg.

spO2 : 94% at room air.

On examination of lower limbs , the pitting type of edema was elicited over the dorsum of both foot.

https://youtu.be/8xgOI7Lwb0U

SYSTEMIC EXAMINATION ::

Respiratory system:

Normal vesicular breath sounds heard.

CVS :

S1 , S2 heard , no murmurs.

CNS : 

No sensory and motor abnormalities.

Per abdomen :

Soft and non tender , no organomegaly.

INVESTIGATIONS ::

Complete blood picture 

Serum electrolytes 

Serum iron:

Blood urea:

Serum creatinine:

ultrasound abdomen :

ECG :

PROVISIONAL DIAGNOSIS :

CHRONIC KIDNEY DISEASE (unknown etiology) on MAINTENANCE HEMODIALYSIS 

Known case of hypertension since 7 years.

TREATMENT ::

Fluid restriction ( less than 1.5litre per day)

Salt restriction ( less than 2gm per day )

Inj . Augmentin 1.2 gm × i.v. × B.D.

Inj. Ciprofloxacin 500mg × i.v.× B.D.

Tab. Nicardia 20mg × po × B.D.

Tab. Lasix 40mg × po × B.D.

Tab. Orofer × B.D.

Tab. Nodosis 500mg × po× B.D.

Tab. Bio D3 0.25 mg × O.D.

Tab. Dolo 650mg × TID.

Blood transfusion was done for treating coexisting anemia.

Q&A ::

Is there any role of hypertension in the development of CKD ??

What are the stages of CKD ??

What might be the cause of anemia in the patient ??