Case 2

 A 57 year old man, who works different jobs for wages, hailing from Miryalaguda presented to the hospital with-

• generalized swelling of legs since 2 days.

Date of admission - 7/10/21.

HISTORY OF PRESENT ILLNESS

• The patient was apparently asymptomatic two years back.

• Patient noticed swelling in their legs one and a half year ago.

• They visited a hospital in Miryalaguda who diagnosed the patient with Chronic Kidney Disease.

• The hospital instructed the patient to start dialysis.

• The patient starts dialysis but the pandemic ensues leaving patient and their family in financial weeds.

• In mid 2020 the patient decides to stop going for dialysis for 8 months.

• At home, the patient usually wakes up by 7am. They do not work or participate in the household activities. 

• The patient then sits out of the house in the sun till lunch. 

• After lunch patient sleeps; to wake up after 2 hours.

• The patient then gathers with their friends and talks to them till it's time for dinner.

• They complete their final meal of the day and then goes to bed.

• One fine afternoon, the patient notices their legs swelling up and his urine output decreasing drastically at the same time. 

• Then, the patient came forward to this current hospital and admitted himself 8 months ago. 

• They have been on dialysis ever since. 

PAST HISTORY

• The patient suffers from Diabetes Mellitus.

• The patient suffers from Hypertension.

• Both Diabetes Mellitus and Hypertension were apparently diagnosed three or four years back, from the time he had the first symptom of CKD.

• The patient doesn't suffer from Tuberculosis.

• The patient also doesn't suffer from asthma and epilepsy.

• They were never involved in any kinds of accidents.

• They have never undergone any surgeries.

• The patient recollects that he had undergone two blood transfusions about a month ago.

PERSONAL HISTORY

• The patient consumes a mixed diet of vegetarian and non vegetarian food.

• The patient was strictly consuming vegetarian diet since the symptoms of CKD appeared 8 months back.

• They are of mesomorphic built.

• They appear to be adequately nourished. .

• There was a gradual onset of reduced micturation.

• Bowel movement is normal.

• They apparently have no habit of smoking.

• They apparently have no habit of drinking.

 

FAMILY HISTORY

• No one in her family complains of a similar problem with similar presentation.

• No one in their family suffers from any genetic conditions or deformities.

• As far as the patient knows, all the deaths in their family were by natural causes. 

ALLERGY HISTORY

• Patient is not allergic to any known drug or food.

• There is no known allergy to dust or pollen in the patient.

DRUG HISTORY

• On equiry, the patient refused to have taken any sorts of steroids, oral diabetes, insulin, ANTIHYPERTENSIVES, diuretics, ergot derivatives, monoamine oxidase inhibitors, hormone replacement therapy or contraceptive pills — prior to coming to the hospital.

GENERAL EXAMINATION

• The patient is concious, coherent and cooperative.

• On examination, patient's mood appears to be well.

• Their built is mesomorphic.

• The patient has oedematous face.

• There is no lymphadenopathy present.

• There is no presence of clubbing.

• The patient has icterus.

• The patient has scratch marks over their legs confirming pruritis.

• There is oedema in both of their legs - pitting type.

• No decubitus is present.

• Patient has substantial pallor and pale tongue; appears to be anemic. 

• Patient appears to be mildly dehydrated.

• Vitals (on examining)

    Temperature- 99.3°F

    Pulse Rate- 81bpm.

    S1 and S2 are heard. 

    spO2- 97.

    Blood Pressure is 143/90.

PROVISIONAL DIAGNOSIS

(?) Chronic Renal Failure secondary to neglected Hypertension.