46M SOB 1.5YRS, DYSURIA SINCE 1.5YRS, APPETITE DECREASED.TELANGANA

 26/10/2026

THIS PATIENT DATA WAS GATHERED BY ROLL NO 17, BATCH 2023 AS PART OF HER  COMPETENCE BASED LEARNING EVALUATION PORTFOLIO PREPARATION.

THIS IS THE CASE OF 46M WITH SOB, 1.5YRS PAIN SWELLING OF LEG, DECREASED URINE OUTPUT(DYSURIA) 1.5YRS AND APPETITE DECREASED

46 years / Male

C/O:

- SOB - 1.5 years, pain - 1.5 years

- Swelling of leg

- Decreased urine output (Dysuria) - 1.5 years

- Appetite decreased

HOPI:

Patient was apparently asymptomatic 2 years ago, then developed SOB on exertion, gradual onset, progressive, MMRC grade III, aggravated by exercise, relieved by rest. No chest pain, wheezing. Developed pitting edema bilateral feet and hands, gradual onset, progressively increasing. Decreased urinary frequency - 4 times/day.

Past History:

AV fistula -> 1.5 years dialysis, 3 times/week for 4 hrs

Personal History:

Diet - Mixed, Appetite - Decreased, Bowel - Normal, Bladder - Oliguria - 4 times/day, Sleep - Normal

AV Fistula Examination:

Radial Artery - Cephalic Vein, Left forearm

Inspection - Scar +, Swelling +, No Redness

Palpation - Thrill +

Auscultation - Bruit +

Provisional Diagnosis: CKD

Age/Sex: 46/M

C/C:SOB - 1.5yrPain & swelling legs - 1.5yrs

↓ urine output - 1.5yrs

Dialysis schedule: Monday & Thursday

Follow up - Pt look dull & weak.

Appetite ↓Pedal edema (+) Last dialysis session - 26/10/26

Here is a colorful infographic summarizing the clinical case, along with a set of Socratic questions to encourage clinical critical thinking about the patient's presentation:

Clinical Case Summary

 * Patient Profile: 46-year-old male

 * Key Symptoms (1.5 Years Duration): Shortness of breath (SOB, MMRC Grade III), pain and progressive bilateral pitting swelling of legs/hands, decreased urine output (oliguria, ~4 times/day, with dysuria), and decreased appetite.

 * History & Interventions: On hemodialysis via a left forearm radiocephalic AV fistula for 1.5 years (scheduled 3 times a week for 4 hours; specifically Mondays and Thursdays).

 * Provisional Diagnosis: Chronic Kidney Disease (CKD).

Socratic Questions for Clinical Reflection

 * Pathophysiology & Fluid Balance:

   * How do the patient's symptoms of shortness of breath (SOB) and progressive bilateral pitting edema connect directly to long-term renal failure and fluid overload?

   * What pathophysiological mechanisms explain the concurrent presentation of oliguria and decreased appetite in advanced kidney disease?

 * Vascular Access & Management:

   * What clinical signs confirm the patency and normal function of the left forearm radiocephalic AV fistula during physical examination (such as thrills and bruits)?

   * Given a dialysis schedule of three times per week, how might interdialytic weight gain contribute to worsening dyspnea and peripheral edema?

 * Complications & Systemic Impact:

   * What secondary systemic complications (e.g., uremic encephalopathy, electrolyte imbalances, or renal osteodystrophy) should be actively screened for in a patient with a 1.5-year history of chronic hemodialysis?

   * How does chronic anemia, commonly associated with CKD, exacerbate the MMRC Grade III shortness of breath reported by this patient?