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59 yr old man with pedal edema and dyspnoea since 3 months

A 59 yr old male patient came to OPD with cheif complaints of B/L pedal edema and sob since 3 months 


HOPI: patient was apparently asymptomatic 3 months ago then he developed B/L pedal edema which is pitting type which is aggravated towards end of the day and subsides in morning  and sob(Grade:2) for which he went to private hospital in suryapet and used medication prescribed by them but he was not satisfied then he went to NIMS in Hyderabad 15 days ago for which they diagnosed him with chronic renal failure and done 2 rounds of heamodialysis on 23.07.22 and 24.07.22 ,the patient came to us for follow up because our hospital is near to his house ,now he is undergoing heamodialysis in our hospital.He also has Periorbital puffiness





PAST HISTORY: Pt had undergone Coronary artery bipass surgery 12yrs ago for IHD and subsequently also developed DM2 and HTN.
Pt had undergone cataract surgery in Right eye 6 yrs back and left eye has immature senile cataract since 2 yrs but being prevented from surgery due to fluctuations in glucose levels and htn.
Pt is not a K/C/O TB,asthma, epilepsy,thyroid disorders.

PERSONAL HISTORY: 
Diet-Mixed
Appetite-Normal
B and B movements- Regular
Sleep- Disturbed 
No addictions

DAILY ROUTINE: Pt is shop vendor by occupation, he wakes up by 7 to 7:30am in mrng and does his personal activities and has breakfast at 9am and goes to his shop and comes to home for lunch at 1 Pm and after having lunch sleeps upto 3.30 pm and wakes up and goes to shop and returns to home for dinner around 8 pm and then he watches Tv and do conversations with neighbours upto 10 pm then he goes to sleep.

TREATMENT HISTORY: pt is on antihypertensives and Oral hyperglycemic agents and also anticoagulants

FAMILY AND ALLERGIC HISTORY: No relevant history 

GENERAL EXAMINATION: 
Patient was conscious, cooperative,well oriented to time,place , person.Moderately built and  lost his weight from 68 kgs to 50 kgs in last 3 months.
PALLOR WAS PRESENT
NO CYANOSIS
NO ICTERUS
NO CLUBBING
NO GENERALISED LYMPHADENOPATHY
NO EDEMA






VITALS::
TEMP AFEBRILE
PR 74 bpm
RR 12cpm
BP 120/80mmHg


SYSTEMIC EXAMINATION:

1.CVS
S1 ,S2 heard
**No murmurs.

2.Respiratory system
**Wheeze -No
**Position of trachea-Central
**Breath sounds-vesicular

3.ABDOMEN
**Shape of abdomen-scaphoid
**Tenderness-No
** Palpable mass-No
** Liver- Not palpable
**Spleen - Not palpable
**Bowel sounds - No

4.CNS
** No abnormalities detected
PROVISIONAL DIAGNOSIS:
Chronic Renal Failure 

INVESTIGATIONS:




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