A 65 yr old female with pedal edema and facial puffiness





























This is an online E logbook to discuss our patient’s de-identified health data shared after taking his/her/guardian’s signed informed consent. 

Here we discuss our individual patient’s problems through series of inputs from an available global online community of experts to solve those patients clinical problems with collective current best evidence-based inputs. 

This e-log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box are welcome.


A 65 year old female came to opd with the chief complaints of fever since 20days ,pedal edema and facial puffiness from the following day 


History of present illness 

Patients was apparently asymptomatic 20days ago then she developed fever which is insidious in onset gradually progressive ,low grade fever, intermittent,   Associated with body pains not associated with chills and rigors and weight loss 

No history of nocturnal variation of fever 

Patient when got fever 20days back she ignored it and went to work(farming) then she developed body pains which were insidious in onset gradually progressive they were unbearable for which she took a injection from local doctor and went for farming again, the following day morning she developed pedal edema and facial puffiness 


Pedal edema was insidious in onset and it was pitting type below the knee 

For which she went to a local hospital in miryalaguda they said to her she is having a kidney problem then she came to our hospital 

Where she as being evaluated and initiated on hemodialysis 


No history of decreased urine output 

No history of burning micturition 

No history of hematuria 

No history of shortness of breath ,cough,palpitations , chest tightness, sweating 

No history of weight-loss 

No history of loss of consciousness,giddiness,involuntary passage of urine and stools 


Past history 

•She had Persistent cough 30years back for which she went to a hospital in mriyalaguda there she was diagnosed as tuberculosis they gave her ATT medication but she didn’t use them regularly (she only used for 3-4days)

•surgeries- tubectomy 35 years back after her 5th child 

Cataract surgery for left eye 6years ago 

Right eye 3years ago 

•Not a know case of hypertension,diabetes,asthma,epilepsy,CAD,CVD 


Family history-insignificant 


Personal history 

Diet-mixed 

Appetite- normal 

Bowel and bladder-regular 

Sleep- adequate 

Addictions-occasionally toddy 

 

Daily routine 

She wakes up at 4am , then complete her household work  and have a cup of tea at 6am then packs herself breakfast leave  for work(farming)by 8:30 -9:00am


At 12:30 she will complete her work and comes home have lunch and sleep for a hour and leave for work at 2:30pm and comes back by 5:00pm have dinner at 8:30pm and sleeps by 9-10 pm 

 

Now as she is having pedal edema and generalised weakness she is unable to go for farming 

And at that time she is sleeping or have chitchat with her grandchildren 


General examination 


Patient was conscious,coherent,cooperative 

Moderately built and moderately nourished 

There were no signs of pallor,icterus,cyanosis,clubbing,lymphadenopathy 

Edema is present 



Vitals

 

Blood pressure- 120/80 mmhg 

Pulse rate -102 bpm 

Respiratory rate -16 cylces per minute 

Temperature-afebrile 


Systemic examination 

Respiratory system 

Trachea centrally located

Shape of the chest 

Bilaterally symmetrical and elliptical 

Chest expansion is equal on both sides 

Auscultation- NVBS heard in Supraclavicular ,Infraclavicular, infraaxillary,

Suprascapular,infrascapular,Interscapular 


Cardiovascular system 

Inspection 

Appears normal in shape 

Apex beat not visible 

No scars,sinuses,dilated veins 

Palpation 

All inspectory findings are confirmed 

Apex beat -5th intercostal space medial to midclavicular line 

Auscultation 

S1 S2 heard 


Perabdomen 

Inspection 

Shape scaphoid 

No scars

No umbilicus inverted 

No dilated veins 

Palpation 

Soft,non tender 

No organomegaly 

Auscultation

Bowel sounds heard 



Provisional diagnosis 

Renal failure, AKI ??


Investigations 


Blood urea 165mg/dl



Serum creatinine 10.3mg/dl 






Chest X-ray 


USG IMAGE 


Ultrasound findings 

E/o multiple cysts noted bilateral kidneys

Largest 26*21mm size in left kidney 

Largest 29*21mm size in right kidney 


Final diagnosis 

Polycystic kidney disease ??

AKI or CKD 

history of pulmonary TB 30years ago 



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