KALVAKOTA MANINITH YA

-D45
Block-6 Sepernber batlkh

Atugqust-21-SepBunbur 3

Melitus type 2
RH 13 Male with knnun hypurknsi on and diabeks
and ecurrerit
TDY the last 20 years presenBcd uith duspna
Assotiakd 6ymptoms noltd
were
9mnths.
bipedal edema or the las
odiqability, Chrmic and pmqressive Cough, decrcaac wne but put
Casu at night: he patient émokts
and humbness in his lowe lugs spedaly
unil 4yor
packs o Claaretes per day and used to dink heaily disres
Bn PEpadiet was Con scirus, Coherant în mid 1epraton
00
mmtlq, HR- 20 bpm, RR- R4/min and
weaght uvas jok BP- 16/1o0
nD mumurs,
heari was adyramic, NRRR,
ae brile the has mild pallor,
erackles bn both lung basts
broih sbunds were ual, but wirth occl
and nm tunde, there was
Do wheets, dbdonen oas ot, NABS, 80
a t prtin edema in boith eet Fundasuopic eraminatiom z7evealed
the 1ctina or both
micmanurysms, ntovasaulanjtaton and enudalu in
yt
and what losnsis
)What are your dillerential diagnoscs are your
och?

NEPHROTIC SYNDROME
Kule In Rule oul

tdema Anumia
loss ok appett
Fataabiluty
 DIABETIC NEPHROPATHY

Rule In Rule Out

Dyspmea No histony o protinuria
Knnon tlyperknsitn No loss o appette
lype & Diabetes Meltus No pain o cramps in
Bipedal edena neck, arms, back or shouldes
Easy nkqability Tinglinq and buning sensatians
Miczoaneuusms, Neovoascu
lanrahion Enudaks in

Reina
Smokingr
Numbness fîn degs

3) CHRONIC OBSTRUCTIVE PULMONARy D1SEASE

Rule Out
Rule n
- Duspneo No chesl pain /chest tiqrtness
Bipedal Edema No sputur
- No wheezes
Easy fodhigability
Cougn
- Occahional Crackles

Smokin
4) CONGESTIVE HEART AILURE
Rule tn Rule Out
Old age, hyputenslon - No muTmuYS

Duspnea, fatiqability -Adynamic teart

Bipedal Edana No ches pain
Chmic and Pnqrusive Corugh Kegudas sththm
- upe Diabeks Mellitys - No abdmina distnsitm
- Mild pallov 01 tundemus.
-

Chackles in Both lunas

 CHRONIC KIDNEY DISEASE CCKD):
Rule In RaAle Ot
Dyspneo
Known typekntion

Type a dabeks Mellitus

Bipedal tdema
Easy uhiqoa bility
ChranicPqyesive Coug
DecreastUaine output
Numbness in lower kos
Crackles on both lungs
Smokinq
a)Aethere tests that. you would wanl done?

Uainalusis rmtnuaia, RBC and wBc tn uine

Albumin to Cvahinine natit (AcR)
3 CBC Anemta, InHlammation, AST ALT wds
4) EC Lv typaophu, Cardiac ythm Chest X-Ray
6) GFe Glomenulan ilhoticm Rak
)unghunchon tst
tb Alc, tstinq lblbod Suqar, total cholusrol, mglucende

What is your initiod impmessin and jationale?

Initia immessipn.-
Chrmic kidney Disease
Kotignale -Parien is knwn tHypetnslve and has type 2 Dabeks
melitusfor last ad yys
- Pahienl has dea eased uzine output suggest kidney injuay and Jead
accu0ulai tn or Huid and salt innht body jesulhng igto
the bodu
bipedal eduna for bst months Fluid ovebad wuld lend +o
 pulmonan tdema dading to dysna and Chronic, pmgessive Cough
CDuan
also also the qeleast ORecs as kidnay qeleass enythropoichin
matunatin and eleae o RBC
As the potient is Smoker and alcoholic until
was an
year ag0
Can wbrsen the above tondtHons and alsothypesHuntion
Due Ho Diabett Retinopathy micmaneuzysms, neovastulanizath on and
enudats) in both ethina o both eys ave seen

4) How ull you Manaqe his patienl?

peahoenl indludes
Manaqe he hputmim by qiuing ACE inhibitors, ARBs and
3- blockns
Gpal: BP o ed uce to <130/ So mm to

e shyle modihiuadin ke Smokinq cessahiom and

Kestictd did, 1esmct Salts, boalanced diet, enercise
Mairain Uine oud pud omd lh
o kg
Diurehies fo edena Cteatnent for fuid oveilod)
heeded manaqe qlucose level wth Insulin
Monitor BP GFR and Creainine