55 yr OLD MALE WITH CKD on MHD
Pt came with complaints of
- Pedal edema
- SOB since 3 months
Patient was apparently asymptomatic 8 months back , then he developed knee & ankle pain in both lower limbs , then he went to local hospital and took medication for that pain relief.
He used that medication 4-5 months ,after he developed pedal edema which was pitting type &
SOB , which was grade 2-3 since 3 months
Past history : k/C/O HTN since 3 months
Not a known case of DM ,asthma,TB , EPILEPSY
Personal history :
Diet - mixed
Appetite - normal
B&B movements - regular
Family history : not significant
ON EXAMINATION :
Pt is C/C/C
Temp : afebrile
BP : 140/80 mmHg
PR : 82 BPM
Rs :22 CPM
GRBS : 105 mg%
General examination
Pallor + , no icterus , Cyanosis , Clubbing , lymphadenopathy
B/L Pedal edema +
On systemic examination :
CVS : S1S2 +
RS : BAE +
Per abdomen : soft non tender
CNS : NAD
Investigations :
ECG
provisional diagnosis : CKD on MHD Secondary to NSAIDS Induced nephropathy
Treatment :
1) salt restriction <2.4 GM/day
2) fluid restriction < 1 lit / day
3) Tab lasix 40 mg Po/TID
4) Tab .NODOSIS 550 mg po/ BAD
5) Tab OROFER XT po/ of
6) Tab SHELCAL 500 mg po/ of
7) inj Erythropoietin 4000 IU / SC weekly once
8) inj iron sucrose 1 amp in 100 ml NS
9) strict i/o charting
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