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  A 55 yr old patient named p.Anji reddy resident of ambala, came to the  Opd with Chief complaints of B/L swelling of legs since 1 week.

HOPI: patient was apparently asymptomatic 2 months back.then he developed fever for which he went to local RMP . Then 1month back he had trauma to left leg.for which he went to local doctor and used some antibiotics. Then he started  developing  bilateral pitting type of edema intially below the knees now progressed above the knees for which he went to NIMS hospital in Hyderabad and undergone 6 session of hemodialysis . patient also developed SOB grade 2.then patient went back to home. Then 7days back he again developed swelling of legs . For which he came to Kim's hospital where he has undergone 3 session of hemodialysis.then at the same time he developed hypertension for which he was on arkamin 0.1mg bd . 12 years back he underwent surgery for the swelling on the head .

Daily routine:

He wakes up at 7:00am in the morning and take breakfast at 9:00am .after that he will go to his fields or he stays at home watching tv. He will not eat lunch .he sleeps for about 2 hours in the afternoon.from 2:00 pm to 4:00 pm.then he watches tv again .he takes his dinner at 8:00pm.and after that he goes to sleep at 9:00 pm.

Past history:

Patient was known case of hypertension since 1month.

No history of diabetes,TB, epilepsy etc  

Treatment history:

Patient was on arkamin 0.1mg bd for hypertension.

Personal history:

Appetite is normal .bowel and bladder are normal .sleep is adequate.

Addiction: chronic alcoholic and smoker since 30years .then he stopped smoking 10 years back.and he stopped drinking 2 months back. No drug and betel nut use 


Family history: no relevant family history.

General examination:

No pallor,icterus , cyanosis,clubbing,and lymphadenopathy.

Bilateral pitting pedal edema on both legs .

Vitals: 

Temperature:99 degree Fahrenheit.

BP: 160/100mmhg.

Respiration rate : 16 cpm.

Pulse rate : 80 BPM.

Spo2 at room air : 98 percentage.

Systemic examination :

CVS:

S1 and S2 are heard .no cardiac murmurs.

RS:

Dyspnea is present.

No wheezing. Trachea is central.

Normal vesicular breath sounds are heard .

Abdomen:

No tenderness and no palpable mass .

Shape of abdomen is obese.

No hernial orifices. Spleen and liver are not palpable .bowel sounds heard.

CNS : 

No focal neurological deficit.

Provisional diagnosis: CRF.

Provisional diagnosis: CRF.

ECG REPORT: 

SERUM IRON:

LFT :

USG REPORT: 

HEMOGRAM : 

COLOUR DOPPLER 2D ECHO :

SERUM ELECTROLYTES:

SERUM CREATININE: 

BLOOD UREA :

TREATMENT: 


Progress after dialysis: 

18/8/22

19/8/22

21/8/22

20/8/22

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