48 years old, an Administration
Assistant from Tangga Batu, Sungai Udang who has been
undergoing renal dialysis for 5 years. He was
diagnosed with renal failure in year 2001. In that
year, his BP was very high and uncontrollable for one
week even after taking antihypertensive drugs. At the
same time patient also felt lethargy, malaise, body
swelling, vomiting, itchiness and decrease urine
output with proteinuria. He lost his consciousness
once after admitted to hospital. Then blood test was
done and renal failure was diagnosed. Initially he
underwent peritoneal dialysis, once in 2 weeks for 6
months. Then in year 2002, he underwent renal dialysis
till now. On examination he is alert and cooperative,
well built and well nourished. He got no pallor,
jaundice, clubbing, cyanosis, pedal edema and
lymphadenopathy. His pulse rate is 89 beats per
minute, normal volume, regular rhythm and no
thickening of vessel wall. BP is 146/89 mmHg. He had
raise urea of 8.5 umol/L and creatinine 636 umol/L. In
LFT, he had raise total protein of 94 g/L, albumin of
56 g/L and globulin of 38 g/L. In lipid profile, he
had raise triglyceride of 3.4 mmol/L. In electrolytes,
potassium is 3.4 mmol/L. In renal profile, he had
markedly raise creatinine of 1485 mmol/L, raise urea
of 22.6 mmol/L, uric acid 490 umol/L and  phosphous
1.8 mmol/L. His PTH was markedly increase, 77.62
pmol/L. In chest X-Ray, mild cardiomegaly and
unfolding of aorta seen. ECG was  normal.

Exploring personal and social background:
He was a smoker for 5 years and has been stop for many
years after married. He likes to drink a lot of water,
eat salty and fatty food even doctor advice him not
to. He is a known hypertensive patient for 8 years. He
took antihypertensive drugs initially and after that
he stopped for 3-4 years before he was diagnosed with
renal failure because he felt that he had recover. He
also had renal stones 8 years ago and operation done
to remove the stones. He has no DM, TB and IHD. In
family history, his father and mother were known
hypertensives. He has 4 children, 3 sons and I
daughter. Both his wife and he are working and the
total income per month is around RM 3500. He not
worried for his dialysis expenses because his company supports it.
He used to work from Monday
to Friday, from 8am till 5pm. But after he was diagnosed
with renal failure and start undergoing dialysis, he has
to take leave for Monday and Wednesday from 1pm to
5pm. Before that, he can do a lot activity like
lifting heavy weight, climb tree to plug fruits, chop
tree, do housework and go for holidays with his family
for many days. But after he get renal failure and
undergo renal dialysis, he start to feel lethargy
easily, cant do hard work like lifting weight and cant
go travel for long and patient only can do some light
gardening work and watch TV only when after work or
free. Patient feels upset and unhappy because of this.

From:
Haw Keong
(4-5-06 11:50pm)