57/M with fever and bilateral pedal edema

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A 57 year old male patient with bilateral pedal edema

57 year old male farmer by occupation

Came with complaints of fever since 3 days.

History of present illness:—

Patient was apparently asymptomatic 4 months back then he developed: 

Bilateral pedal edema, pitting type, insidious in onset, gradually progressive from ankle to below knee

H/o dcreased urine output

No h/o palpitations or burning micturition or chest pain.

C/o B/L knee pain since 4 months

Patient went to the outside hospital were renal function tests were done and he was found to have raised urea and creatinine levels

Patient was taken for dialysis (total of 12 dialysis were done), last session 15-3-22 (today)

He was diagnosed with hypertension at the same time and is on regular medication(Tab. NICARDIA 10MG)

Patient came to our hospital for dialysis and central line placement was tried but failed and hence patient was put on conservative management. 

Past history:—

H/o HTN since 4 months

N/K/C/O DM, TB, BA, Epilepsy

Personal history:—

Appetite- normal

Bladder movements:— decreased urine output

 bowel movements- regular

Patient takes alcohol (180ml 2-3 times/week)

Smokes beedi (2-3/day)

Treatment history:-

History of NSAID's abuse (takes tablets when he has knee joint pains)

General examination:—. pt is c/c/c well oriented to time place and person.

Temp- 98F

Bp- 130/80mmhg

Pr- 78 BPM

RR- 17cpm

Grbs:- 126mg%

No c/o pallor,icterus,cyanosis,clubbing,lymphadenopathy.

H/O pedal edema.

Systemic examination:—

CVS- S1 S2 heard

RS- BAE (+)

P/A soft, non tender

CNS- NFND

CNS- NFND

Investigations:-

Serum creatinine :—  6.1mg/dl

Provisional diagnosis:— NSAIDs induced nephropathy with hypertension

Plan :-

Conservative management:— T. LASIX 20mg PO/BD

T. ULTRACET ½TABLET QID. -dialysis.