55 year old male with pedal edema, facial puffiness , SOB and cough since 3 months

 A 55 year old male daily wage labourer by occupation resident of Choutuppal came to casualty with the c/c of pedal edema since 3 months, sob since 2 months and cough since 2 months. 

Patient was apparently asymptomatic 2 months back then he developed bilateral grade 2 pedal edema pitting type which was insidious in onset and gradually progressing along with facial puffiness in the same time period. He also complained of SOB which was insidious in onset and gradually progressing, aggravated on doing his regular work(Granite cutting) with no relieving factors even after taking medication. 

The patient had a history of occasional cough on and off, usually productive, since 2 months while doing his work which subsided on otc medication. 

He was a chronic alcoholic and smoker for 30 years and stopped consuming alcohol and smoking 10 days back.

 No h/o blood vomiting, fever and burning micturation. 

No h/o DM, HTN, TB, Asthma 

He also had a past history of right sided traumatic eye injury when hit with a stone. No significant past and family history. 

He was taken to a hospital in Nalgonda where he was asked to get usg abdomen done and diagnosed with poly cystic kidney disease and referred to KIMS for further evaluation and treatment. 

General Examination

Patient was conscious, coherent and cooperative 

Temp - afebrile 

Pr 72bpm

Rr 20 cycles/min

BP 140/70 mmhg 

Spo2 99% at room air 

Systemic Examination 

CVS - 

S1 s2 + 

No murmurs 

RS - BAE + 

NVBS + 

Abdomen- soft, non tender, no palpable mass 

CNS - No focal neurological deficits (NAD) 

Provisional diagnosis- Polycystic Kidney Disease with Chronic Renal Failure 

USG - 

2D ECHO - 

CHEST X RAY

ECG- 

CLINICAL IMAGES - 

TREATMENT - 

1. TAB. NICARDIA 20 mg BD 

2. TAB. NODOSIS 500 mg BD

3. TAB. OROFER XT PO BD 

4. INJ. ERYTHROPOIETIN 4000IU WEEKLY ONCE 

5. TAB. SHELCAL PO OD

6. INJ. THIAMINE 100 mg in 50 ml NS IV/TID 

7. Fluid and salt restriction