44 yr old male with renal failure

44 year old Toddy climber, climbing around 40 trees per day , from the age of 20, at 23 he was diagnosed with dm2 started on oha,due to symptoms of polyuria, was on regular followup of his dm2 , had complaints of leg pain for which he used nsaid's frequently ,3-4times per week, diagnosed with renal failure with initial creatinine 2.5 in 2019, but was on same medication, followed up every 6 months ,in January 2020 ,in a follow up his creatinine was rising , which didn't subside after consulting ?physician so he was on follow up with an ayurvedic doctor,he also developed symptoms of pedal edema which reduced with that treatment,he didn't report any symptoms of decreased output ,in March 2020 he was admitted for loc in miriyalguda ,told to have high sugars with increased creatinine and was started on insulin, he lost follow up with ayurvedic doctor and pedal edema didn't subside with medication so he went to nims where biospy was done , and he was started on hd , that point his creat was 5gm/dl, he has been undergoing dialysis ever since

He came with 
C/o lower limb swelling since 20 days
Sob(grade-3) since 20 days
Generalised weakness since 20 days

patient was apparently asymptomatic 3 yr back, then he developed weakness of left upper and lower limbs for which he went to the hospital and was diagnosed to have HTN. (Medications prescribed but never taken) 

C/o lower limb swelling since 20 days - Insidious in onset, gradually progressive from involving ankle to above knee , b/l pitting type

Sob(grade-3) since 20 days- insidious in onset,sob while talking and walking to washroom

Generalised weakness since 20 days

Palptations +

No burning micturition 
No cough 
No chest pain 
No orthopnea 
No PND
 
Past history:
HTN since 3 years
 diabetic since 13 years
No h/o TB, Asthma, epilepsy

Surgical history : under went cataract surgery
                               at 23 years
Personal history:
Occasional alcohol consumer
Occasional tobacco abuser 
No NSAID abuse

Family history:
Father is a k/c/o DM

O/E:
Temp- afebrile to touch   
BP-150/80mmhg
Pr-90/min                             
Spo2-96% on RA
Rr-20/min      
Palor- present 
No- icterus, cyanosis, lymphadenopathy
B/l-pedal edema present 

Cvs-S1S2 heard, 
Jvp raised
RS- BAE+, NVBS 
P/A: distended, soft, non tender
CNS: NAD



Diagnosis:
Renal failure due to hypertension

TREATMENT:
Fluid restriction < 1L/day
Salt restriction <2-4 gm/ day
TAB. LASIX 40 MG PO BD
TAB. NODOSIS 500 MG PO BD
TAB OROFER XT PO BD
TAB SHELCAL PO OD
TAB NICARDIA 10 MG PO BD
TAB. DOLO 650 MG PO BD
MONITOR VITALS







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