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

USG:

Findings: B/L grade III RPD Changes 

Diagnosis:

?Hypertensive Nephropathy 

Investigations:

Hb- 7.5 

Na-140

K-4.4

Cl-101

Serum creatinine- 14.6

Urea- 194

Treatment:

Tab Lasix 40 mg BD

Tab Nicardia 10 mg BD

Tab Orofer XT OD

Tab Nodosis 500 mg OD

Tab Shelcal CT OD

Fluid and Salt restriction