A 42 YEAR OLD FEMALE WITH C/O PITTING TYPE PEDAL EDEMA,FACIAL PUFFINESS, DECREASED URINE OUTPUT

 A 42 year old female came to the OPD with C/o

   -pitting type of pedal edema since 11months

   -facial puffiness since 11 months

   -decreased urine output since 11months

  - Shortness of breath (SOB) since 3 months

  - Abdominal distension since 3 months


Patient was apparently asymptomatic 11 months back, then in jan'21 ; she developed

• swelling in both feet, ankles,legs 

Which was insidious in onset, gradually progressive ( started in feet and ankles and progressed upto thighs (i.e) grade-3)


• decreased urine output since 11 months


• Shortness of breath since 3 months, insidious in onset gradually progressive

 (NYHA grade-3 )


• Abdominal distension since 3 months

NO H/O chest pain, palipations, fever , sore throat, joint pains.

NO H/O hemoptysis , wheezing

NO H/O pain abdomen , jaundice


Past history:

  •2 years ago ,She complaints of giddiness & went to RMP & was diagnosed with HTN & on tab. Nifedipine 10mg /PO/OD ( Irregular)


She was diagnosed with CKD and is on hemodialysis since 11 months 


No DM,TB, ASTHMA, EPILEPSY



Personal history:

 appetite - decreased

Sleep - disturbed

Urine output-decreased

Bowel movements- regular

No addictions


No significant family history


Surgical history :

1 cesarean section & tubectomy


General physical examination:

Patient is conscious, coherent, cooperative

Moderately built & nourished



 

Pallor - +

No icterus, cyanosis, clubbing,koilonychia, lymphadenopathy.

Edema- + (pitting type)

Arterio- venous fistula for hemodialysis is present on right forearm with palpable thrill 





Vitals: 
Temp- afebrile
BP - 150/90 mm HG
PR -88 BPM
RR- 17 CPM
 Systemic examination:
CVS-. S1S2 heard , no Murmrs
RS - BAE +; NVBS
P/A - soft , non tender

CNS - Hmf intact .

Provisional diagnosis:-
CKD on MHD

USG report-


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