Bilateral pitting edema of lower limb 20days

Male patient of age 75 comes in opd with compalin of bilateral swelling of lower limb Chief Complaints Swelling both lower limbs History Of taking Nabivolol 5 mg+trimetazidine since 3 years for bp Tab: thyroxin 50 Tab Nftor 100 mg +fluvoxate bd for uti since 10 days Vitals Bp:120/70 Pulse:70 Physical Examination Pallor Pitting edema Urine frequency 5/7 but less amount Investigations Hb:12.5 S.tsh: 5.8 S.creatinine:1.6 rise Lft nad Urine R/M: Pus cells 14-15 Diagnosis AKD?? Uti?? Management ???

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Patient is a c\o Renal disease, with Creatinine raised. Tsh raised mild Increase dose of thyroxine by 12.5mg Avoid beta blocker in hypothyroidism Give Temisartan+ cilnidipine Nefrosave bd Dytor plus 5 od Niftran bd Limb elevation Avoid protein riched food

Thank you doctor.
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Reduction in renal function due to age and UTI. Prolonged sitting posture Hypoproteinemia ? Reduced LV functions ? Varicose veins Suggest diuretics , foot elevation . Elastocrepe stockings

Old age pt kco CRF hypothyroidism Present complaints are due to Ckd Needs sr electrolytes To be managed by diuretics If not responding than dialysis may be option

Thank you doctor.
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