THIS PATIENT DATA WAS GATHERED BY ROLL NO 6 BATCH 2023 AS PART OF HER COMPETENCE BASED LEARNING EVALUATION PORTFOLIO PREPARATION
THIS IS THE CASE OF A 23F ON REGULAR HEMODIALYSIS, SWELLING OF BOTH LOWER LIMBS, INCREASED URINE OUTPUT AND REQUIRES TWICE A WEEK DIALYSIS
*Demographics*
- Age / Sex: 23 years / Female
- Occupation: Student - Degree
*Chief Complaints*
- Pain in the back at age of 15 years
- Swelling of limbs - 6 months
- Facial puffiness - 3 months
- Giddiness - 2 months
*History of Present Illness*
- Patient was apparently normal 8 yrs ago, then developed easy fatigability & generalized weakness. Symptoms are insidious in onset & gradually progressive in nature.
- Swelling of both feet since 6 months. The swelling is bilateral and associated with facial puffiness.
- There is loss of appetite & disturbed sleep.
- No H/O chest pain, hemoptysis, fever
- No H/O burning micturition, hematuria, recurrent UTIs.
- Requires twice a week dialysis
*Past History*
- Patient is known case of HTN for 7 years and on regular medication with Clonidine Hydrochloride (Arkadin -100)
- N/K/C/O DM, Asthma, thyroid, Epilepsy, CAD, TB.
- No previous surgeries in the past
*Personal History*
- Diet - Mixed
- Appetite - Reduced
- Sleep - Disturbed
- B & B - Regular
- Addictions - Nil
*General Examination*
- Patient is conscious, coherent, well oriented to Time / Place / Person
*PICCLE*
- P - Negative (-)
- I - Negative (-)
- C - Negative (-)
- C - Negative (-)
- L - Negative (-)
- E - Positive (+) - Non-pitting B/L pedal edema
*Vitals*
- Temp - Afebrile
- BP - 130 / 80 mmHg
- RR - 22 bpm
- PR - 84 bpm
*Systemic Examination*
- CVS - S1, S2 (+) Heard
- CNS - NFND
- RS - B/L NVBS (+)
- P/A - Soft, NT
*Provisional Diagnosis*
- CKD
2/11/2026
THIS PATIENT DATA WAS GATHERED BY ROLL NO 36 BATCH 2023 AS PART OF HER COMPETENCE BASED LEARNING EVALUATION PORTFOLIO PREPARATION
THIS IS THE CASE OF A 23F ON REGULAR HEMODIALYSIS, SWELLING OF BOTH LOWER LIMBS, INCREASED URINE OUTPUT CAME TO HOSPITAL FOR SCHEDULED DIALYSIS
*Demographics*
- Age / Sex: 23 years / Female
- Occupation: Student
*Chief Complaints*
1. Swelling of both lower limbs - 5 years ago
2. Increased urine output
- Known case of kidney failure, on regular hemodialysis
- Came to the hospital for scheduled dialysis
*History of Present Illness*
- Patient was apparently asymptomatic 5 years ago, then she gradually developed swelling over both limbs
- Swelling - initially mild & gradually progressed
- She consulted local hospital, where investigation revealed - Kidney related anomaly
- Prescribed regular medication, discontinued
- Subsequently, her kidney function progressively deteriorated
- Eventually resulted in kidney failure (end stage)
- Then advised hemodialysis
- Has been undergoing regular dialysis since then
- At present the patient has come to the hospital for her scheduled hemodialysis
*Past History*
- HTN since 5 years
*Treatment History*
- Initially treated with prescribed medication
- Sarad... tablet since 2 years
- Dialysis
- Frequency
- Duration
*Personal History*
- Appetite - Normal
- Diet - Non-veg
- Sleep - Normal
- B & B - Normal
- Addictions - Nil
*Family History*
- No significant family history
*General Physical Examination*
- Patient conscious, coherent to Time / Place / Person
- Pallor - Absent
- Icterus - Absent
- Cyanosis - Absent
- Clubbing - Absent
- Lymphadenopathy - Absent
- Edema - Present, pedal edema present (pitting type)
*Systemic Examination*
- CVS - S1, S2 (+)
- CNS - NFND
- RS - NVBS (+)
- P/A - Soft, NT
*Provisional Diagnosis*
- CKD
2/11/2026
PATIENT DATA AS ON 2/11/2026 BY ROLL NO 35 BATCH 2023 AS PART OF HER COMPETENCE BASED LEARNING EVALUATION PORTFOLIO PREPARATION
*Demographics*
- Age / Sex: 23 years / Female
- Occupation: Student
*Chief Complaints*
- 1) Swelling of both lower limbs - 5 yrs ago
- 2) Increased urine output - 5 days
- Known case of kidney failure, on regular hemodialysis. Presently came to hospital for scheduled dialysis.
*History of Present Illness*
- Patient was apparently asymptomatic 5 yrs ago then developed swelling in both lower limbs initially mild & gradually progressed as she consulted local hospital, investigation revealed kidney related problem. Presently patient came to hospital for routine haemodialysis.
- No H/O fever & wt loss.
*Past History*
- H/O HTN since 5 years.
*Medication History*
- Currently on HTN medication
- N/K/C/O DM, Epilepsy, TB, Thyroid
*Personal History*
- Diet - Mixed
- Sleep - Normal & Sound
- Appetite - Normal
- B & B - Increased urination - 5 days
- Addictions - Nil
*Family History*
- Not significant
*General Examination*
- Pt is C/C/C well oriented to T/P/P
*PICCLE*
- Negative (-), Bilateral Pedal Edema (+)
*Vitals*
- Temp - Afebrile
- RR - 20 bpm
- BP - 130 / 90 mmHg
- PR - 92 bpm
- SpO2 - 98% @ RA
*Systemic Examination*
- CVS - S1 S2 (+), no murmur
- CNS - NFND
- RS - BLA (+), NVBS
- P/A - Soft, NT
*Investigations*
- CBC
- Blood urea
- Serum Creatinine
- Urine routine
- Urine protein
- Serum albumin
*Provisional Diagnosis*
- CKD Stage V
Here is a set of Socratic questions tailored for medical students based on the 23-year-old female patient case report. These questions are designed to guide clinical reasoning from initial presentation to differential diagnosis, complications, and long-term management.
Phase 1: Pathophysiology & Clinical Presentation
* Lower Limb Swelling: The patient presented with bilateral pedal edema and facial puffiness. What underlying physiological mechanisms in renal failure cause this type of fluid retention and facial puffiness, and why is it typically non-pitting early on or pitting later in the course?
* Hypertension History: The patient has a 5-year history of hypertension predating her formal chronic kidney disease (CKD) stage V diagnosis. In this young patient, how do you determine whether hypertension was the cause of her kidney disease or the result of primary glomerulopathy or another renal parenchymal disease?
* Symptom Timeline: The patient experienced back pain at age 15 and swelling 5 years ago. Could an insidious onset of symptoms in an adolescent delay diagnosis, and what specific clues in her history might point toward a chronic glomerular etiology rather than an acute insult?
Phase 2: Diagnostics & Evaluation
* Initial Investigation: When a young patient presents with generalized weakness, fatigue, and progressive pedal edema, what are the baseline laboratory tests required, and how would you interpret blood urea and serum creatinine to stage her kidney disease?
* Urinalysis Significance: In evaluating a patient suspected of CKD, what specific findings on urine routine and microscopy (such as proteinuria, hematuria, or casts) would help differentiate between a glomerular cause (e.g., glomerulonephritis) and a tubulointerstitial cause?
* Secondary Complications: Given her history of long-standing chronic kidney disease, what routine screening labs or imaging modalities should be ordered to assess for common CKD complications like mineral and bone disorder (CKD-MBD) or anemia?
Phase 3: Management & Renal Replacement Therapy
* Hemodialysis Access & Adequacy: The patient requires regular hemodialysis twice a week. Based on her clinical stability, how do nephrologists determine the ideal frequency and duration of dialysis sessions, and what parameters measure treatment adequacy?
* Medication Review: The patient has been managed with antihypertensives like Clonidine Hydrochloride. How does progressive loss of renal function alter the pharmacokinetics and pharmacodynamics of drugs commonly used in CKD patients?
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