General medicine case 4

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A 60 year old female who is daily wage labourer by occupation came with the chief complaint of

1. Lower back pain 

2. Facial puffiness

3. Pedal edema

History of present illness :

- Patient was apparently asymptomatic 4 months back then she developed fever and backache for which she was treated symptomatically. She used to take analgesics for a temporary relief from the backache.

- Later when the conditions repeated again, she was taken to a local hospital where she was diagnosed with kidney failure.

- She is currently undergoing dialysis twice a week.

History of past illness : 

- The patient is a known case of hypertension since 6 years and is on medication.

- She is not a known case of diabetes, epilepsy, tuberculosis, asthma.

Personal history : 

- The patient has loss of appetite since 2 days

- She takes mixed diet

- She has proper bladder movements

- She has constipation

- She is unable to sleep since 2 days

- No addictions 

Family history :

- There are no similar complaints in the family members

Treatment history :

- She is not a known case of any drug allergy

General examination :

- Patient is conscious, coherent, cooperative at the time of joining

- Pallor is present

- No icterus

- No cyanosis

- No clubbing of fingers and toes

- No lymphadenopathy

- pedal edema js present which is of pitting type

Vitals : temperature - 98.5 F

              Pulse rate - 82 bpm

              Respiratory rate - 18 cycles per minute

              BP - 140/90 mm Hg

Systemic examination : 

CVS

Inspection - chest wall is bilaterally symmetrical

- No precordial bulge 

- No visible pulsations, engorged veins, scars, sinuses

Palpation - JVP is normal

Auscultation - S1 and S2 heard

RESPIRATORY SYSTEM

- Position of trachea is central 

- Bilateral air entry us normal

- Normal vesicular breath sounds heard

- No added sounds

PER ABDOMEN 

- abdomen is not tender

- bowel sounds heard

- no palpable mass or free fluid

CNS

- Patient is conscious

- Speech is present

- Reflexes are normal

Investigations :

Hemogram : 

Serum electrolytes : 

Serum creatinine : 

Serum iron : 

Blood urea : 

RBS : 

Serology : 

Ultrasonography : 

ECG : 

Diagnosis : Chronic kidney disease 

Treatment : 

- fluid restriction < 1.5 litres per day

- salt restriction < 2 g per day

- Tab. Lasix 40 mg OD

- Tab. Nicardia 20 mg BD

- Tab. Livogen BD

- Tab. Nodosis 500 mg OD

- Tab. Bio D3 0.25 mg OD

1. What are the various causes of CKD other than induction by analgesic drugs ?

2. What are the effects of CKD on gastrointestinal tract ?

3. What other organs are affected by analgesics?

4. What is the limit of dosage for taking analgesics that wouldn't cause kidney diseases ?