45/F cook by occupation

 45 year old with pedal edema

 A 45 year old female, cook by occupation, mother of two, came to the OPD on 21/1/22 with chief complaints of loss of appetite and  vomiting since 2 months 

Pedal edema since 1 year

No c/o Shortness of breath, decreased urine output, burning micturition.

The patient was apparently asymptomatic 1 year ago then she developed pedal edema, on and off,  upto mid calf level ,which relieved on walking. 

C/o facial puffiness on and off since 1 year 

The pt went to a hospital in Nalgonda for the same where her Sr.creat was 11.0

The pt was advised for dialysis I/v/o high serum creatinine but they were not willing to get it done and so was started on medication after which her serum creatinine came down to 7. 

The pt has been using the same medication since the past one year with which she was comfortable  as her complaints subsided and was leading a normal life.

Since 2 months  ago she developed loss of appetite and vomiting for which she went to a private hospital. 

She was referred to KIMS, NKP for dialysis I/v/o high serum creatinine.

Patient is a k/c/o Hypertension since 1 year, on medication.

Not a k/c/o DM, TB, Asthma, Epilepsy 

Vitals:

Temp- 98.6F

BP- 140/80 mmhg

PR- 86 bpm

RR- 17 cpm

Spo2- 99% at RA

GRBS- 94 mg/dl

General Examination:

Patient is conscious/coherent/cooperative 

Moderately built and well nourished

Pallor +

Icterus -

Cyanosis -

Koilonychia -

Lymphadenopathy-

Pedal edema + upto ankle 

CVS- S1 S2 + No murmurs 

RS- BAE+ No added sounds 

P/A- Soft, Non tender 

CNS- NAD

Dx-ANASARCA DUE TO GLOMERULAR INJURY,

ANOREXIA DUE TO AZOTEMIA

Treatment-

FLUID AND SALT RESTRICTION

T. LASIX 40MG PO/BD

T. NICARDIA 10MG PO/BD

T. OROFER XT PO/OD

T. NODOSIS 500MG PO/OD

T. SHELCAL CT PO/OD

2/2/22 24hr URINARY PROTEIN CREAT RATIO-

25/1/22

Hb- 7.5

RBS- 94

Blood urea- 194mg/dl

Creat- 14.6

30/1/22

Blood urea- 123

Creat- 9.7

2/2/22

Urea- 70

Cret- 7.3

Lipid profile- TOTAL CHOLESTEROL- 207

TRIGLYCERIDES- 81

HDL CHOLESTEROL- 42

LDL CHOLESTEROL- 98

VLDL- 16.2

Hb- 6.6

24 hr Urinary protein- 1938 mg/day, 

24hr urine volume- 1700ml

4/2/22

T3- 0.80

T4- 12.93

Tsh- 7.81

Urea-

25/1-194

30/1-123

2/2/22-70

Hb- 

25/1/22- 7.5

2/2/22- 6.6

4/2/22- 8.2

Creat- 

25/1/22-14.6

30/1/22 -9.7

2/2/22- 7.3

29/1/22- 1st dialysis session

1/2/22- 2nd dialysis session

3/2/22- 3rd dialysis session