50YR OLD FEMALE WITH CKD ON MHD,k/c/o HTN 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 

* FEVER since 4 days.

* SHORTNESS OF BREATH since 4 days.

HOPI ::

Patient was alright 1yr ago  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 ::