A 55 year old from Aiti pamula who was a farmer came with C/o decreased urine output ,pedal edema,sob since 4 years Patient was apparently asymptomatic 4 years back then he developed bilateral pedal oedema (pitting type), gradually progressive, a/w sob and h/o decreased urine output. No h/o palpitations,burning micturition. He was diagnosed with CKD and was undergoing 2 sessions of dialysis per week since 4 years because of which he stopped the agricultural work. K/c/o HTN since 4 yrs -ON tablet Nicardia 10mg Not a k/c/o DM,TB,ASTHMA, EPILEPSY,CAD. No significant family history ON EXAMINATION: PATIENT IS CONSCIOUS,COHERENT , COOPERATIVE. Pallor- present B/L Pedal edema (pitting type) present No icterus, clubbing, cyanosis, koilonychia,generalised lymphadenopathy. TEMP-AFEBRILE. PR-83BPM BP-120/80MMHG RR-17CPM SPO2-98 GRBS-121MG/DL CVS-S1S2+ RS-BAE+,NVBS. CNS-NAD P/A- soft, non-tender,BS+ INVESTIGATIONS- ON 22/12/2021 BLOOD UREA-79MG/DL SERUM CREATININE-7.4MG/DL SODIUM-148MEQ/L POTASSIU