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49 years old male with CHRONIC KIDNEY DISEASE associated with osteoarthritis of knee

chief complaints:
A 49-yr-old patient came with OPD with chief complaints of -bilateral knee pain and Lower bach ache since 2 months.-pedal edema since 1 week.-shortness of breath since 1week.-decreased appetite since 1 week.





history of presenting illness:-Pt was apparently assymptomatic 2 months ago, then he devoleped B/L knee pain which was insidious in onset ,gradually progressive ,pain increase on work for which he used NSAID’s prescribed by local RMP for 15-30 days and stopped -he devoleped pedal edema 1 week ago which was insidious in onset and initially restricted to below ankle then progressed above ankle level which is not relieving on rest and not associaed with feverhttps://drive.google.com/uc?export=view&id=1ggyIBBatrHhy3o2eip2aRrZU62xrbYKa
-he devoleped grade II shortness of breath 1 week ago
DAILY ROUTINE:
Patient used to be a farmer by occupation but he stopped 2 montgs back due to increased knee pain and was mostly confined to his home ad surroundings. He wakes up at around 5:30 AM and freshens up. He will be having breakfast at around 10 AM and then rest for sometime.He has lunch around 1PM and rests for an hour. In the evenings he spends time with his family. He will be having dinner around 9 PM and goes to bed.
PAST HISTORY:
No H/O fever,HTN,DM,Coronary artery disease,Cerbrovascular accident,thyroid disorders,asthma,TB
PERSONAL HISTORY:
Diet:MixedAppetite:DercreasedSleep:adequateBowel and bladder movements:Normal with normal micturationAddictions:Alcohol and tobacco since 20-30 yrs.
FAMILY HISTORY:
No significant family history
GENERAL EXAMINATION:
Pt was C/C/C well oriented with time place and person and moderatly build.
Pallor - Present
https://drive.google.com/uc?export=view&id=1SiRvnNfu2wgcSfDzJs5CDgF87L0wSzfa

Icterus - absent Cyanosis-absentclubbing-absent Lymphadenopathy-absent
VITALS:
Heart rate : 76bpmBP: 80/60 mmHgRR:16 cycles per minTemp:98.6F
SYSTEMIC EXAMINATION: Patient is conscious
CNS:Speech normalNo signs of meningeal irritating
Motor and sensory system- Normal
Reflexes - present
Cranial nerves - intact: 
CVS: S1 and S2 heardRESP. system:NVBS+, trachea-central 
ABDOMEN: inspection   shape :scaphoid with no distention   equal symmetrical movements in all quadrants              with respiration   No visible pulsations and peristalsis.
PALPATION: no hepatomegaly and no splenomegaly
ASCULTATION: Bowel sounds heard
INVESTGATIONS:
https://drive.google.com/uc?export=view&id=19jsqDxMdwW_AhnijjlvanvCGnrH-QWeV

https://drive.google.com/uc?export=view&id=16RHH4b9H-Ey92ArxupX_oR09ajysccfzhttps://drive.google.com/uc?export=view&id=1UPf-ScDlE-t9EeZvRSrJQoqmeTfQp7Duhttps://drive.google.com/uc?export=view&id=1O80Yput4M8EHE9_3ZorAwKW_FqgjeVX0

PROVISIONAL DIAGNOSIS:
CHRONIC KIDNEY DISEASE ASSOCITED WITH OA KNEE
TREATMENT:
https://drive.google.com/uc?export=view&id=1mvvlS91LyvVUZ9ax0pJwBiPMllkULeZB







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