55 year old female with k/c/o DVT came for maintenance hemodialysis

 A 55yr old female , home maker came to the hospital for maintenance  hemodialysis 

Pt was apparently asymptomatic 4 years back then she had fever and decreased appetite for which she went to outside hospital,and diagnosed with Grade 2 RPD and her creatinine was 3.5gm/dl

In 2021, she took unani medications,her creatinine came down from 3.5 to 3.1 gm /dl after which she discontinued taking medications.

In 2022 Jan,her creatinine was 4.5gm/dl and so adivsed dialysis. She underwent 6 sessions of dialysis, later her 3 way femoral line came out , from which she had lot of bleeding, and then diagnosed with DVT of right lower limb,Heparin was given then.Presently, she is on warfarin.Now, she came to hospital for maintenance hemodialysis.

PAST HISTORY-
Known case of Diabetes mellitus , since 10 years, onTab.Glimiperide, 
Known case of Hypertension , since 10 years,on Tab
 Metoprolol,

T.LASIX 40mg PO BD
T. OROFER-XR PO OD


Personal history
Sleep- Adequate 
Appetite- decreased
Diet- mixed
Bowel movement- Regular
Addictions- nil

On examination
Pt is C/c/c
Pallor +
No Icterus ,Cyanosis, Clubbing,Lymphadenopathy
Edema of feet + 

Vitals
Pr:84bpm
Bp:130/70
Spo2:99%at RA
Temp - Afebrile
Grbs - 166 mg/dl

Systemic examination
CVS - S1,S2 +
RS - BAE + 
CNS - NAD
P/A- Soft, non tender








Investigations
Serology - Negative
Blood Urea:86 mg/dl
APTT-37secs
PT-20secs
INR-1.4
S.Creatinine: 4.6 mg/dl
RBS: 201 mg/dl

USG:


Hemogram:

CUE:

Doppler
2d echo 


Provisional Diagnosis 
Renal impairment with K/C/O DVT with h/o Hypertension and Diabetes mellitus


Treatment
Fluid restriction (<1.5l/day)
Salt restriction (<2g/day)
T.ECOSPIRIN 75 mg PO OD
T.ATORVAS 10 mg PO OD
T.ACITROM 2mg PO OD
T.LIVOGENPO OD
T.SHELCAL CT PO OD
T· LASIX 40 mg PO BD.


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