53 yr female with CKD

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A 53 year old female patient came to opd with chief complaint of :

- shortness of breath since 3days .
- decreased urine output.  

History of present illness:

Patient was apparently asymptomatic 12 years back, she developed high grade fever for which she visited Nalgonda govt hospital, they performed investigations and told her that her kindeys were damaged. Her fever resolved with medication and she went home. 
Later in her life, 4 years ago she was experiencing chronic bouts of neck pain, giddiness, and headache, for which she visited Nalgonda govt hospital, where she was diagnosed with hypertension. Ever since she has been on anti hypertensive drugs.

10 months back she developed SOB, for which she visited the hospital, investigations there reavealed that her blood pH, blood urea and creatinine were raised.

She was diagnosed with renal failure. For which she underwent dialysis  2-3 times every week. She had blood transfusion 2 times during dialysis. 

Three days back she developed shortness of breath and decreased urinary output, yet again.

PAST HISTORY:

There was a history of HTN 10 years back, on medication since 10 years.

NO H/O DM, ASTHMA , TB, EPILEPSY.





Personal history:

Appetite - normal

Diet - mixed

Bowel movements - regular

Bladder - Decrease urinary output

No allergies
No addiction

Family history:
No significant family history



General examination:-

Patient was consious,coherent,and cooperative,well oriented with time and place.

Vitals :-

Bp - 150/90

Temperature - 98F

Pulse:86

Pallor - present
Icterus - absent
Clubbing - absent
Cyanosis - absent
Lymphadenopathy - absent
Oedema - bilateral pedal oedema which is pitting type and grade 2

CVS
Normal s1 and s2 sounds heard
No cardiac murmurs

RESPIRATORY SYSTEM
Normal vesicular breath sounds heard
Respiratory crepts present on right 

P/A
Soft, non tender, bowel sounds +

CNS 
no FND, GCS - 15/15, no signs meningeal irritation, motor system normal.

Clinical pictures

Investigations

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