67/F with CKD on MHD since 2 years

This is online E log book to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs. This e-log book also reflects my patient centered online learning portfolio and your valuable inputs on comment box is welcome .

CHIEF COMPLAINTS: 
Patient came with complaints of: 
-decreased urine output since 3 months 
-bilateral swelling of lower limbs since 3 months 

HOPI: 
Patient was apparently asymptomatic 2 years back, then she developed decreased urine output, bilateral pedal edema and was diagnosed to have renal failure with heart failure and was in conservative management since 3 months the symptoms have progressed. Patient was initiated on hemodialysis. 


Past History: 
K/c/o DM2 since 25 years 
K/c/o HTN since 20 years 
On regular medication for both. 
N/K/C/O Asthma, CAD, CVD, Epilepsy, TB 

Personal History: 
Appetite: Normal
Diet: Non-veg 
Bowel: Regular 
Bladder: Decreased frequency
Sleep: Adequate 
Addictions: None

Family History:
Insignificant

Menstrual History: 
Last menstrual cycle: 20 years ago

General examination:
No Pallor, Icterus, Clubbing, Cyanosis, Lymphadenopathy. 
Edema of the legs- present 

Vitals at Admission: 
TEMP: 98.4F
BP: 130/60MMHG
PR: 91 BPM
RR: 16 CPM
SpO2: 95
GRBS: 230 mg/dl

Systemic Exam: 
CVS: S1S2 + 
RS: BAE + 
CNS: NFND 
P/A: Soft, Non-tender, No organomegaly


USG on 25/04/23: 
Impressions: 
1. Grade II RPD changes notes in bilateral kidney
2. Left renal calculi 
3. Right pleural effusion
4. Grade I fatty liver 

25/04/23: 

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