55 yr old male with polycystic kidney disease

 55 Yr old male, granite cutter by occupation presented to casualty due to swelling of both the feet.

Chief complaints: 

Swelling of both the feet and shortness of breath from past 2 months.

𝓗𝓲𝓼𝓽𝓸𝓻𝔂 𝓸𝓯 𝓹𝓻𝓮𝓼𝓮𝓷𝓽𝓲𝓷𝓰 𝓲𝓵𝓵𝓷𝓮𝓼𝓼 :

 Pt. Was asymptomatic 3 months back then he developed "wet cough". ( on and off type) 
2 months back he developed shortness of breath while doing work. 
It was aggravated by work and not relieved by meds. 
He also had pedal oedema( non pitting type) and facial puffiness  since 2 months. 
No h/o blood vomiting, no h/o fever. 

Past history: 

He got his right eye hit by a hard stone due to which he lost his  right eye vision permanently. 

He's not a known case of TB/ DM / ASTHMA / epilepsy. 

Personal history: 

Mixed diet 

-Reduced appetite 

Adequate sleep

-Irregular bowel movements 

-Consumes Alcohol and tobacco from past 30 years. 

-Pt. has Burning micturition. 

Family history : 

No relevant family history. 

General physical examination:

Pallor - present 

Cyanosis- absent 

Icterus- absent

Lymphadenopathy: absent

Oedema: Non pitting type  oedema present on both the feet.

Vitals - 

Temperature- Afebrile

Pulse rate- 72 beats per minute.

Respiratory rate- 20 breaths per minute. 

B.P - 140/70 mm hg

Spo2 - 99% at room air

Systemic examination: 

CVS:- S1 and S2 are heard,NO MURMUR

RS:- BAE+ , NVBS+

P/A SOFT ,NT

CNS : 

Pt. was conscious, coherent and co-operative.  

Speech was normal. No slurred speech. 

No meningeal signs.

- No abnormality detected. 

Reflexes: 

Right and left biceps, triceps, ankle and supinator show grade 2 reflex.

Gait: 

Normal.

                        Investigations

1. Colour doppler 2D echo: 

Suggesting of diastolic dysfunction. 

Findings include sclerosed aortic valve,

Dilated left atrium,

Left ventricle- Dilated, concentric, LVH.

2. Complete urine examination: No abnormality detected. 

3. Ultrasound report: 

    Multiple cysts are found in kidney.

       

4. HEMOGRAM: Findings include decreased Hemoglobin, lymphocytes,  rbc count and elevated RDW CV.

 5. Blood sugar is within normal range. 

6. Renal function tests: 

      Findings include 

Highly elevated urea and creatinine. 

Calcium levels are decreased 

Phosphorous and sodium levels are increased.

7. Liver function test: 

Elevated direct bilurubin and alkaline phosphate. 

Decreased protein levels. 

8. ECG 

2D echo of heart 

Cysts of Rt. Kidney 

Cysts of left kidney

Provisional diagnosis: 

Polycystic kidney disease, CRF

Treatment: 

Fluid and salt restriction.

T. Nodosis 500 mg BD 

T. Orofer xt PO BD 

Inject erythropoetin 4000 IU weekly once

T. Shelcal PO OD

Inject thiamine 100 mg in 50 ml NS  I.V / TID 

T. Nicardia 20mg BD