41 M with Breathlessness ( CKD )

PRESENTING COMPLAINTS 
A 41 year male clinically presented to nephrology opd with complaints of : 
breathlessness of since a month
Pedal edema since a month
Anuria since a day.

HOPI :
A 41 year male clinically presented with complaints of breathlessness of grade III MMRC, insidious onset, gradually progressive,  not associated with seasonal and diurnal variation, not associated with orthopnea, postural nocturnal dyspnea and chest pain. History of grade II pedal edema since a month insidious onset and gradually progressive,  pitting type, not associated with local rise in temperature, and skin changes. History of anuria since a day.

PAST ILLNESS : 
History of bilateral knee Joint pains at the age of 8 years, patient sought for donsultation and started on NSAID, which he used for a year. 
History of bilateral lowerlimb weakness for which he sought for consultation and was diagnosed with hypokalemia paralysis, that relieved after K+ correction. 
He had complaints of Headache for which he sought for consultation and was diagnosed to be having Hypertension and started on antihypertensive medications. (K/C/O HTN Since 15 years)
In 2009, he experienced sudden severe Headache for which he sought for consultation and was diagnosed as Hypertensive urgency and started on ARBs and  CCBs, after 5 years on routine checkup he was diagnosed with renal disease with serum creatinine of 3.5 mg/dl and started on Medical management of CKD (in 2014). In 2015 he had severe breathlessness and anasaca,  he was initiated on hemodialysis via Right IJV followed by Left BC AV fistula, hemodynamically was done twice weekly.
In 2018, he applied for jeevandhan, and was called for renal transplantation in 2020, unfortuately he had covid 19 in 2020, and was not accepted for transplantation. 
In 2022, he had alleged history of RTA in Dec 2022, and underwent PFN placement. 

PERSONAL HISTORY:
Moderately built and nourished. 
Appetite decreased.
Sleep adequate. 
Regular bowel movements. 
No urinary output. 
No known allergies. 
No addictions. 

FAMILY HISTORY:
Mother,  Father and Sister had both HTN and T2DM.
Brother has HTN.

GENERAL PHYSICAL EXAMINATION:
Pallor present.
Pedal edema grade II.
No Icterys, cyanosis, clubbing, lymphadenopathy.
JVP absent.

VITALS:
Afebrile to touch, Temp: 98.6°F.
PR 92 bpm, BP 150/90 mmHg, RR 22 cpm, SpO2 98% @room air. 
GRBS : 111 mg/dl.







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