case 12

40year old male
DOA -20/3/24
DOD -10/4/2024
CKD duration- 1 year 
And on maintenance hemodialysis since 6months.

Diagnosis -
CKD ON MHD
K/C/O HYPERTENSION

 CHIEF COMPLAINTS -
C/O SWELLING OF B/L LOWER LIMB C/O FACIAL PUFFINESS C/O SOB ON EXERTION HISTORY OF PRESENT ILLNESS
PATIENT WAS APPARENTLY ASYMPTOMATIC 1 YEAR AGO, THEN HE DEVELOPED B/L PEDAL EDEMA. FACIAL PUFFINESS, AND SOB ON EXERTION NO H/O ORTHOPNEAL PND NO H/O BURNING MICTURITION NO H/O HEMATURIA NO H/O ABDOMINAL PAIN

 PAST HISTORY
K/C/O HYPERTENSION-1 YEAR AND ON MEDICATION(20 MG0 N/K/C/O EPILEPSY/ CVA/ CAD/ THYROID DISORDERS GENERAL EXAMINATIOPATIENT IS C/C/C
NO PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, EDEMA present.
PR-82BPM
RR-16CPM
BP-140/90MMHG
SPO2-98%
CVS-S1,S2 HEARD, NO MURMURS
RS-BAE+
P/A- SOFT, NON TENDER, NO ORGANOMEGALY
CNS-NFND
Investigation
24HR URINE/CREATININE RATIO-
24 HRS URINE PROTEIN- 136.2MG/DAY
24 HRS URINE CREATININE-0.7G/DAY
RATIO-0.19
URINE VOLUME-200ML
HEMOGLOBIN-9.7GM/DL
MCV-87.8
MCH -27.3
MCHC-31.9
TLC -9600
PLT-2.14

S IRON -44
S FERRITIN -280
SMEAR
RBC-NORMOCYTIC NORMOCHROMIC
WBC-WITHININ NORMAL LIMIT
HEMOPARASITES-NO HEMOPARASITES SEEN
IMPRESSION-NORMOCYTIC NORMOCHROMIC
RFT-
UREA-75MG/DL
CREATININE-10.0MG/DL
URIC ACID-2.7MMOL/L
CALCIUM-9.6MG/DL
PHOSPHORUS-4.1MG/DL
SODIUM-136MMOL/L
POTASSIUM-4.4MMOL/L
CHLORIDE-103MMOL/L



LFT-
TOTAL BILIRUBIN-0.79MG/Dl
DIRECT BILIRUBIN-0.20MG/DL
SGOT(AST-19IU/L
SGPT(ALT-16IU/L
ALKALINE PHOSPHATE-103IU/L
TOTAL PROTEIN-6.5GM/DL
ALBUMIN-3.6GM/DL
A/G RATIO-1.25
BLOOD SUGAR RANDOM-RBS-91MG/DL
COMPLETE URINE EXAMINATION-
COLOUR-PALE YELLOW
APPEARANCE-CLEAR
REACTION-ACIDIC
SP.GRAVITY-1.010
ALBUMIN- ++
SUGAR NIL
BILE SALTS NIL
BILE PIGMENTS NIL
PUS CELLS 3-4
EPITHELIAL CELLS-3-4
RBCS NIL
CRYSTALS NIL
CASTS NIL
AMORPHOUS DEPOSITS ABSENT
OTHERS NIL
BLOOD GROUPING-
BLOOD GROUP-B
RH TYPING-POSITIVE
ANTI HCV ANTIBODIES RAPID-NON REACTIVE
HBS-AG RAPID-NEGATIVE
HIV1/2 RAPID TEST-NON REACTIVE
USG REPORT-
RT KIDNEY-7.8X3.5CM
LT KIDNEY-8.7X3.4CM
IMPRESSIONS- BILATERAL PLEURAL EFFUSION.
-B/L GRADE II-III RPD CHANGES
2D ECHO-
MODERATE MR, MODERTAE TR WITH PAH, MODERATE AR
NO RWMA, MILD CONCENTRIC LVH+
ALL CHAMBERS DILATED
GOOD LV SYSTOLIC FUNCTION
NO DIASTOLIC DYSFUNCTION
NO PE/CLOTS

INTERVENTIONS
ORAL IRON THERAPY -DAILY TAB.OROFER XT
IV IRON THERAPY -TWICE /WEEK
EPO -YES
EPO DOSING -ONCE/WEEKS
PRBC TRANSFUSED -0
ADMISSION IN ICU -0



Treatment Given(Enter only Generic Name)
FLUID RESTRICTION <1.5L/DAY
SALT RESTRICTION <2GM/DAY
T.NIFEDIPINE XL 30 MG PO/TID
T. TELMA 80 MG PO/OD
T. DYTOR 100 MG PO/OD
T. MET XL 25 MG PO/BD
T.SHELCAL- CT PO/OD
T.OROFER-XT PO/OD
T.LASIX 40 MG PO/OD
T.ARKAMINE 0.1MG PO/TID
INJ. EPO 4000 IU SC/ BI WEEKLY
INJ. IRON SUCROSE 100MG IV/ ONCE WEEKLY


Advice at Discharge
FLUID RESTRICTION <1.5L/DAY
SALT RESTRICTION <2GM/DAY
T.NIFEDIPINE XL 30 MG PO/TID
T. TELMA 80 MG PO/OD
T. DYTOR 100 MG PO/OD
T. MET XL 25 MG PO/BD
T.SHELCAL- CT PO/OD
T.OROFER-XT PO/OD
T.LASIX 40 MG PO/OD
T.ARKAMINE 0.1MG PO/TID
INJ. EPO 4000 IU SC/ BI WEEKLY
INJ. IRON SUCROSE 100MG IV/ ONCE WEEKLY

FOLLOW up at 3months 
HB -7.4
MCV -85.4
MCH -26.2
MCHC -30.2
TLC -8800
PLT -2.24

Follow up at the end of thesis -
Death due to CVA in

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