polycystic kidney disease

A 75 years old Male farmer presented to the medicine opd with the
 Chief  complaints of 
Swelling of both the feet ,ankles and hands and facial puffiness since 10 days.


He also complained of back pain since 2 years and swelling in the left inguinal region since 1 year.


Patient being a farmer used to go to his field regularly and was living his normal life.he used to eat regularly and was able perform all his daily activities on his own.Then 2 years back he developed back pain but he neglected. Then 1 year back he developed pain and swelling  in the groin and was getting problems in performing his daily activities as he was not able to bend forward and was getting pain while lifting heavy weight.He went to  local doctor and doctor said that he needs to get a surgery done but as an old villager he was scared of surgery and he kept on doing his work in spite of having pain and swelling.Then 10 days ago he took covid vaccine and he developed swelling in both the hands,legs and facial puffiness.Then they got scared and went to some hospital.There he was said that he has kidney problem and he came to our hospital. 

HOPI :
 Patient was apparently asymptomatic 2 years back,then he developed back pain.

swelling in left inguinal region since 1 year which was sudden in onset,progressive in nature, reduced on lying down,and reappearing while working.

Pedal edema in both the feet and ankle  since 10 days.it is sudden in onset,gradually progressive,and there is no aggravating or relieving factor.

Pain : back pain and vague abdominal pain (mainly in the loin region)since 10 days.
Pricking type of pain.
There is no radiation. 
No aggravating or relieving factor.

Complaints of decreased urine output since 3 days is also present. 

Negative history  :
No breathlessness, chest pain,orthopnea,pnd,palpitations 
no loss of weight 
No hematuria
No constipation and hoarseness of voice



Past history  :
No similar complaints in the past.He is not a known case of hypertension, diabetes, epilepsy, TB ,CAD.

Family history  :
None of his family members has such problems. 

Personal history  :
Diet: mixed
Sleep adequate 
Bowel movements : did not pass stools for 1 day(5days back)
decreased micturition since 3 days.
Appetite normal
Alcoholic and smoker(bidi 1 packet per day)

EXAMINATION

GENERAL EXAMINATION  : 
Patient is conscious, coherent, cooperative, well oriented to time,place and person,moderately built and Nourished. Examined after taking consent.

*Pallor is present
Pitting type of Bilateral pedal edema present.*

There is no clubbing, cyanosis,icterus, lympathadenopathy




Pallor and pitting type of edema :


Multiple  nodules are found  on both the hands,thighs and chest 
Which are non tender,soft, moveable.
Present since  50 years and genetic.









Vitals : 
Temperature afebrile. 
Pulse rate 82 bpm
Respiratory rate 18 cpm
BP 160/100  mm of Hg



Systemic examination  :
done after taking proper informed consent.
 CVS : s1,s2 +
Respiratory system: BAE +
Per abdomen: obese abdomen,no palpable mass is found, tenderness in the both side of abdomen. No hepatoslpeenomegaly.bowel sounds heard.
CNS : NAD

Investigations:














Provisional  diagnosis  : 
Adult polycystic kidney disease  and left sided inguinal hernia.(with anemia)



Follow up 
13th November, 2021.
He came for dialysis.
When I met him he was lying on bed comfortably and He is cooperative always. 
He is feeling better. 
He has back pain which is pricking type and tingling sensation in his hands and feet.
Appetite is decreased. 
Bowel and bladder movements are normal. 

Examination:
CVS s1s2 heard
Respiratory BAE +
Per abdomen no palpable mass found, Bowe sounds heard
CNS NAD


Hemogram: 
Haemoglobin 7.6 gm/do
PCV 23.6 vol%
RBC count 2.70 million/Cumm

Serum electrolytes 
Chloride 95mEq/L

Serum Creatinine 
7.4 mg/dl

Blood urea
93mg/dl 

Random  blood sugar 
194 mg/dl 


Follow up on 18/11/2021
He was waiting for his 5th dialysis in our hospital. 
His appetite is decreased 
Urine output is decreased 
Bowel is regular 
He got fever at night after dialysis 
Sleep adequate 

When I checked, he was afebrile 
Pulse rate was 64 bpm
Respiratory rate was 18 cpm

He asked me what to eat and what to avoid. 
I asked PG sir and then told him to take less salt,less meat,mainly red meat.
And to eat more leafy vegetables.














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