A 57 year old man with generalized swelling in his legs since 10 days.

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 micturition.

• 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.


IMAGES








DISCUSSION


1) How does Hypertension cause Chronic Renal Disease?

2) What are the reasons for patients to NOT take a medicine prescribed by a doctor? How do medical professionals deal with this issue?


[This case is taken with P Dinesh, J Sai Karthik, K Meghanapriya, and M Yashaswini.]


Comments

Post a Comment

Popular posts from this blog

A 60 year old man with pedal oedema since 15 days, dypnea since 5 days, fever since 5 days.

Image
 A 60 year old man, who worked as a lorry driver, presented to the hospital with- • Pedal oedema of since 15 days, • Dyspnea since 5 days, • Fever since 5 days, • Decreased urine output since 3 days, Date of admission - 2/2/22 HISTORY OF PRESENT ILLNESS • Patient was apparently asymptomatic 15 days back. • Patient wakes up at 6am every morning. He has his lunch at 2pm. He sleeps in the afternoon. He has dinner at 9pm and sleeps by 10pm. •Patient is an ex lorry driver and lives a very sedentary life.  • 15 days ago, they developed pedal oedema of pitting type — which extended upto ankles. • They also presented with fever, which was continuous since 5 days. • Patient also presented with grade 4 shortness of breath since 5 days. • Vomiting of one episode which was non projectile 5 days back. • Patient also suffered with uncontrolled hemoptysis since 5 days back.  • 3 days ago, when the pt. was undergoing dialysis, the patient suffered from a cerebro vascular accident.   PAST HISTORY • The
Read more

A 60 year old man with reduced micturition and defecation since 2 months.

Image
 A 60 year old man, who works as a coolie, presented to the hospital with- • reduced micturition and defecation since 2 months. • burning sensation on micturition since 2 months. HISTORY OF PRESENT ILLNESS • Patient was apparently asymptomatic 2 month back. • The patient is a retired coolie who does nothing of significance in the day. • He wakes up at 6am, roams around his village, settles disputes, and retires for the night at around 10pm. • 2 weeks after Dusshera (2 months back), patient suffered with a dizziness spell and cough which he attributes to "cold". • Patient was taken to an ENT specialist who ruled him clear of any problem. • The very same day, the patient noticed an acute decrease in his urination and micturition. • When patient was taken to the hospital in Nakrekal where he was diagnosed with Renal failure.  • He was put on Maintainance Hemodialysis since then. • Patient recollects that after 5 days of dialysis, patient's micturition and defecation was som
Read more