ckd

A 40 year old male resident of Nacharam came with the complaints of Shortness of breath,facial swelling,pedal edema.
C/o abdominal distention since 25 days.

Pain in the epigastric region.
C/O decreased urine output since 25 days.

The patient was apparently asymptomatic 4 months back .He used to go for work (farming) before 4 months .Suddenly he developed cough along with Shortness of breath ,for which he was taken to private hospital in Nalgonda where he was diagnosed with kidney failure and was advised to undergo dialysis.
He Underwent 6 sessions of dialysis for a period of 9 days ,and SOB  was relieved with dialysis.
After that he came to OPD where he is diagnosed with CKD and advised for dialysis later he developed pedal oedema after 20 days of the first visit ,the edema is of pitting from below knees ,the edema subsides for  2 days after the dialysis session and patient develops edema later until the next session .
He also complaints of abdominal distention since 20 days associated with pain in the epigastric region .The pain is of squeezing type  ,non radiating not associated with palpitations, sweating, giddiness, syncope,blurring of vision or blackout 

The patient is a known case of HTN since 4 months and is on Tab Nicardia 20mg/PO/TID 
And Tab Arkamine(0.1mg) po/bd.
 He was a occasional alcoholic ,he takes 90 ml of whisky occasionally. 
 Personal history:
 Appetite-normal
 Bowel-regular
 Decreased urine output 
 No relevant family history 
 Previous USG on 23/12/2021
 Grade 3 RPD
Gross ascitis 
 Blood urea:55mg/dl
 Serum creatinine:6.3mg/dl
 Hb:6.3
 TLC:25,700
 
 On 17/1/2022
 Bp:140/90mmhg
 Temp:Afebrile 
 Pr:94bpm
 Rr:30cpm
 Grbs:122mg/dl

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