70 /M with pedal edema

70 year old male farmer by occupation came with complaints of pain in bilateral lower limbs and edema since 6 months 
Neck pain radiating to hands since 1 month 

Patient was apparently asymptomatic 20 years back then he developed pain and generalised weakness of body for which he stopped working as farmer and started to stay near his farm animals as rancher and with almost sedentary life style 

3 years back patient developed pain in multiple joints increased with movements so went for local practioner and was taking occasional pain killers (?nsaids) once every 2 months 

6 months back patient started to develop swelling of both lower limbs from the level of thighs and associated with pain in the lower limbs, oliguria since 1 month then came to our hospital and was investigated 
Found to have 
Serum creat :4.5
Urea:152
 K : 5.3
Usg : Bilateral grade 2 rpd changes , lt simple Cortical cysts
Patient was started on Tab Lasix 

Pedal edema subsided and is grade 2 pitting type 
Not associated with chestpain , sob, syncope ,fever .
Pain not subsided 
Associated with tingling of lower limbs 

History of neck pain radiating to back and hands since one month
Not associated with giddiness , tinnitus, palpitations 

Personal history
Diet mixed ( stopped non veg 6m back)
Appetite decreased 6m back improved now
Toddy intake stopped 15 y back
Sleep normal

Patient not a known case of dm, htn ,asthma, CAD, tb ,epilepsy.

General examination:

70 year old male conscious coherent cooperative
Well oriented to time place and person

Vitals : 
BP 140/80 mm of Hg
PR 82 bpm regular rate rythm 
RR -16cpm
Temp afebrile 
Pallor +
Clubbing -
Cyanosis - 
Lymhadenopathy -
Edema ++ bilateral pitting type of pedal edema 
No raised jvp

CVS- S1, S2 heard No murmurs or additional heart sounds 

Resp - bilateral air entry present , No crepts 
Normal vesicular breath sounds present 

Git - perabdomen soft , non tender

Provisional diagnosis : 
Chronic kidney disease










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