General Medicine :Case-1
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August 9,2021
A 60 yr old male patient,resident of suryapet presented to opd with cheif complaints of shortness of breath,swelling in the legs and decreased urine output since 3 months.
History of present illness :-
Patient was apparently asymptomatic 3 months back then there was shortness of breath since yesterday.
There is pedal edema since few days .
There is decrease in urine output since few days .
Also there is associated back pain.
There is burning sensation during micturition.
Patient also has weakness .
Past History:-
Patient is a known hypertensive and diabetic since 16 years and he is taking medication for both.
Once 8 years back with problem of pedal edema he went to hospital and doctors have diagnosed as kidney failure and patient took medication .
On medication problem of pedal edema had reduced but it was recurring.
Personal history:-
Patient has normal eating habit.8 yrs back he used to eat mixed diet but from 8 yrs he is a vegetarian.
Apetite is normal.
He has habit of alcohol.
Bowel movements are regular.
Decreased urine output.
Inadequate sleep .
Family history :-
No significant history in his family.
On general examination:-
Patient is conscious ,coherent,cooperative lying in supine position on the bed in well lit room.
Moderately built.
Patient is pallor.
Bipedal edema is present .
No cyanosis.
No jaundice.
No clubbing of fingers.
No lymphadenopathy.
Vitals:-
Temperature:Afebrile
Pulse Rate:-100/min
Respiratory rate:-22/min
Bp:-140/90 mm/hg
Spo2:- 98%
Grbs:-144mg%
Systemic examination:-
CVS:-
S1 S2 heard
Respiratory system:-
Bae present ,no abnormalities .
CNS:-
No focal neurological deficits.
Provisional diagnosis:-
Chronic kidney disease on MHD.
Investigations:-
Complete blood picture :-
Haemoglobin:- 6.8 gm/dl
(Normal range:13-17)
Total count:-4800 cells/Cumm
(Normal range:4000-10000)
Neutrophils:-60%
(Normal range:40-80)
Lymphocytes:-30%
(Normal range:20-40)
Eosinophils:-01%
(Normal range:1-6)
Monocytes:-09%
(Normal range:2-10)
Basophils:-0%
(Normal range:0-2)
Platelet count:-1 lakh/Cummins
(Normal range:1.5-4.1)
Smear-Normocytic normochromic anemia with thrombocytopenia
Serum creatinine:-6.8mg/dl
(Normal range:0 9-1.3)
Method:-Modified Jaffe's
Blood urea:-101 mg/dl
(Normal range :12-42)
Method:- Urease-GLDH
Serum Electrolytes :-
Sodium:- 128 mEq/L
(Normal-136-145)
Potassium:-3.3 mEq/L
(Normal:-3.5-5.1)
Chloride:-90 mEq/L
(Normal:-98-107)
All the tests were done by Ion selective electrode method.
Serum iron:-73.9 ug/dl
(Normal-61-157)
Method:FERENE
Anti HCV antibodies-Rapid test:-
Non reactive .
Method:Immunochromatography.
Anti HIV 1/2 Rapid test:-
Non reactive.
Method ::Immunochromatography
ECG:-
Questions:-
1)Is diabetes the main cause for ckd in this patient?If so he had diabetes since 16yrs,why might the problem of ckd arised since 8 yrs?
2)If he would have started dialysis before 8 yrs when he knew it has ckd ,would the problem solved or it would re occur again?
3)Why Anti-Hbc and Anti-HIV tests are done?
4)What might be the reason of blood urea increasing so high?
5)What is the difference between diabetic nephropathy and ckd?Will diabetic nephropathy lead to ckd ?
Case history taken by:-
A.Shruthi.
A.Rashmitha.
B.Sravanthi.
