CKD with ADPKD


This is an a online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss out individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.

 This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

I have been given this case to solve  in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehensing clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

An informed consent was taken from patient/ attender and there is omission of information that was requested to be omitt

A 52 yr old male chief complaints 

Swelling of Bilateral lower limbs since 10days Decreased urine output since 10 days Shortness of breath since 5days.              

History of present Illness::-

Patient was apparently asymptomatic 5 yrs  ago then he developed  episode of vomiting, decreased urine output, decreased appetite and deviation of mouth to right side with weakness of upper and lower right limbs( Stroke ) for which he consulted local  physician and incidently his creatinine levels were 4mg/ dl

.1month back he developed Swelling of Bilateral lower limbs upto knees.Decreased urine output . Lackof Appetite,Nausea and generalised weakness for which he went to hospital and his creatinine levels were 12mg/dl undergone Dialysis for 3 consecutive days.

10 days back Swelling extended upto knees and pitting of edema and declined to some extent on lying down.

SOB grade 4MMRC , orthopnea present for which he is undergoing Dialysis.

Past History::-

K/c/o Hypertension since 10 yrs .using Nifedipine 5mg

N/k/c /o DM,, Epilepsy,TB, Thyroid , Asthma

Personal History::-

Mixed diet 

Loss of appetite 

Bowel  movements regular

No known addiction and allergies

Treatment History::-

Patient undergone cardiac bypass surgery 14yrs ago and sugery for Renal Caliculi 20 yrs back.

GENERAL Examination::-

Patient is conscious, coherent ,co cooperative

He is moderately build, moderately nourished 

Pallor present 

No icterus, clubbing ,cynosis

Edema present upto right knee 

Generalised  lymphadenopathy :No 

VITALS::- 

Bp: 160/90mm Hg 

PR:80bpm

RR:16cpm

Afebrile 

SYSTEMIC Examination::-

CVS: S1,S2  heard ,no murmurs

Resp : Bilateral air entry present,normal vesicular breath sounds 

CNS:NFND 

Per Abdominal examination:-

Inspection:-

Distended Abdomen,full flanks ,skin stretched, Umbilicus everted ,no visible peristalsis , equal symmetrical movements in all quadrant’s with respiration , no dilated abdominal veins 

Palpation - 

No local rise of temperature, no tenderness

All inspectory findings are confirmed by palpation.

Kidney is palpable bimanually 

No tenderness 

Percussion:- Tympanic note

Ascultation

Investigation::-




PROVISIONAL DIAGNOSIS:-

CHRONIC KIDNEY DISEASE with AUTOSOMAL DOMINANT  POLYCYSTIC KIDNEY DISEASE (CKD with ADPKD)


Treatment:-
-T.CLINIDIPINE 20mg
- T.Met-xl 500 mg
- T.LASIX 40 mg
- T.NODDSIS 500 mg
- FLUID RESUSCITATION 
- SALT RESTRICTION 
- INJ.NITROFURANTOIN 200 mg
- INJ.ERTHYROPOIETIN 4000IU

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