65 yr man with dyspnea since 1 week B/L pedal edema since 1 week and abdominal distention since 1 week

 This is an online E log book 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 available global online community of experts with an aim to solve those patient's 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 is welcome.

Here is a case i have seen:


 65 year old man presented with the complains of
Dyspnea since 1 week
Bilateral pedal edema since 1 week
Abdominal distension since 1 week
Reduced urine output since 5 days 
 
He used to work as a carpenter at Nalgonda. His wife works as a daily wage labourer. He started having bilateral knee joint pains since 15 years for which he started taking 'pain killers' as described by the patient and the attendant.
10 years back, at his work place, he had a laceration on his left index finger for which he visited a local hospital where in he was diagnosed to be a diabetic and also he was told that his kidneys reduced in size. He was put on certain oral medications and was also started on Metformin 500mg for diabetes.
5 years back, he had one episode of GTCS after which he was started on Tab Levipil 500mg, twice daily which he only used for a period of 6 months.
Since 1 year he has been having  bilateral lower limb swelling  on and off. He stopped taking the oral medications prescribed for his kidney problem 6 months back.
Since 1 week he started experiencing Dyspnea on exertion which progressed to Dyspnea at rest since 1 day, after which he developed bilateral lower limb edema and abdominal distension.
Since 5 days he has also been having reduced urine output.

On examination, patient is Obese
Pallor+
Could not assess his apex beat
S1, S2 +
Lungs - Bilateral ISA expiratory wheeze+

His old reports show that he was diagnosed to be hypertensive and was prescribed amlong 10mg 3 years back which he never used. 
His cue shows albumin 2+ in 2018. And serum creatinine was 4mg/dl.
Investigations 
Provisional diagnosis
CKD secondary to diabetes and NSAID use
Known case of type 2 DM and hypertension 
? Anemia of Chronic disease
Investigations 

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