65y Male with c/o Pedal edema and SOB(CKD on MHD)

CC:
C/o swelling of legs since 15 days
C/o SOB since 15 days
C/o facial swelling since 30 days
C/o difficulty in urine flow since 30 days
HOPI:
Pt was apparently asymptomatic 15 days back then he developed c/o swelling of both legs, SOB since 15 days, c/o facial swelling and difficulty in flow of urine since 30 days.
C/o swelling in both legs:
pitting type
appears upon sitting down with legs hanging down
decreases upon lying down, walking
not a/w any pain/tingling sensation
not a/w claudication pain
no overnight swelling noticed upon sleeping
C/o SOB:
Occurs after walking some distance. Decreases upon taking rest -Grade 2 
No Orthopnea
No PND
C/o Facial swelling:
NLF present
not a/w any pain/itching
no pigmentation
C/o Difficulty in flow of urine:
Reduced flow of stream of urine
Sensation of retention of urine present
Urge to urinate repeatedly present
No. of times pt urinates/day-
Day: 2-3 times
Night: 3 times
No hematuria/pyuria
No burning micturition
No involuntary ejaculation of semen in urine

Past History:
10yrs back, the pt while working on tractor fell down hence stopped farming since then. He injured his Right hip from fall for which traction was given but no surgery was performed. Pt underwent 10 sessions of Hemodialysis in the month of December in 2019 and January 2020 and May 2021.

H/o HTN since 10yrs. On medication NICARDIA retard.

Vitals @ Admission:
BP:110/80 mmHg
HR:90bpm
RR:18cpm
TEMP: 98.7 F
SpO2: 97% on RA
GRBS: 98 mg/dL

General Examination:
Pt is c/c/c
No Pallor/Icterus/Cyanosis/Clubbing/Koilonychia/Lymphadenopathy
Edema present- b/l legs, pitting type
Facial edema present
Thyroid Normal

Systemic Examination:
CVS: S1S2 heard, No murmurs
RS: BAE+,NVBS
CNS:NAD
P/A: Soft,Non tender

Provisional diagnosis:
CKD on MHD

Investigations and Reports:

Treatment:
TAB. NICARDIA 10mg PO OD
TAB. NODOSIS 500mg PO BD
TAB. ARKAMINE
TAB. LASIX 40 mg PO OD
TAB. OROFER XT 500mg OD
TAB. SHELCAL 500mg OD

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