A 50 year old male with pedal edema

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I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

[  ] A 50year old Male came to opd  with CHEIFCOMPLAINTS of pedal edema,facial puffiness since 1year and sob since 6 months.


[  ] HISTORY OF PRESENT ILLNESS......
Patient was apparently asymptomatic  1year ago then he developed bilateral  pitting type of pedal edema which is sudden in onset and gradually progressive the edema first starts in the foot then Progresses to ankle And then to knee joint which is aggravated on walking Or doing any work and relieved on keeping the legs on height
And then patient developed shortnes of breath 6months back which is aggravated during sleep after having his meal  after a sleep of 2hours and then relieved by walking for some time (grade 2).
No history of palpitations .
No history of fever.
No history of sweating.
No history of PND.

[  ] PAST HISTORY...
He is hypertensive since 2 years and no history of tb ,asthama ,epilepsy ,CAD,DM .
[  ] PERSONAL HISTORY....
DIET mixed
Appetite. Decreased
Sleep inadequate
Bowel and bladder regular
Addictions :he was an smoker and alcoholic but stopped smoking and taking alcohol since 3years .
[  ] FAMILY HISTORY........
NO significant family history.

[  ] GENERAL EXAMINATION.....
Patient is conscious coherent and cooperative.
Well oriented to time place and Person
Comfortabaly lying on the bed.
Moderately built and modeartely nourished .
The patient is anemic and icterus present and bilateral pedal edema present.
No cyanosis and clubbing.
VITALS:
PR:104bpm.
Bp:140/80mmhg
RR:20CPM.
TEMP:Afebrile.
[  ] SYSTEMIC EXAMINATION....
RESPIRATORY SYSTEM:BAE +,NVBS+

CVS:S1+S2+,No murmurs.

PER ABDOMEN :
Shape :scaphoid.
Tenderness:no tenderness.
Palpable mass: no palpable mass
Bowel sounds heard
No spleenomegaly and no hepatomegaly.

CNS:No focal neurological dedialysis.

[  ] INVESTIGATIONS:

LIVER FUNCTION TESTS

CUE:

BLOOD GROUPING AND RH TYPING:

SERUM IRON

RENAL FUNCTION TESTS:

COMPLETE BLOOD PICTURE:

ECG:

USG ABDOMEN:

Provisional diagnosis:

Ckd which is maintained on heamo dialysis

TREARMENT::