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1. Hypertensive

2. N hypertension on telmisartan. He presented with a history of bilateral lower limb pitting edema non-painful for 4 months, unrelated to posture, with no fever. There were no complaints of exertional dyspnea, palpitations, or air hunger at night. Over the past 3 days, he reports experiencing headaches but denies any history of blurry vision or altered mental status. Other system reviews including gastrointestinal and central nervous system were essentially normal. The patient reports a positive history of chronic NSAID use whenever he experiences any pain.Physical Examination:On examination, bilateral lower limb pitting edema was noted without associated pain. Vital signs were within normal limits. No abnormalities were detected upon cardiovascular, respiratory, or neurological examination.Investigations:Ultrasound scan (USS) revealed small-sized kidneys with coarse echotexture and increased echogenicity, indicative of chronic kidney disease (CKD) with loss of corticomedullary differentiation (CMD),had elevated Creatinine levels 1300micromol/l,Urea 40mmol/l,normal ALT/AST levels.Assessment:The patient’s clinical presentation, history of diabetes mellitus, hypertension, and chronic NSAID use, coupled with USS findings, suggest chronic kidney disease as the underlying pathology for the bilateral lower limb pitting edema.Plan:The patient was counseled regarding renal replacement therapy options, but he expressed a preference for possible transplant evaluation. He has requested to be treated where his family resides for ease of follow-up. Referral for transplant evaluation will be arranged accordingly.Follow-Up:The patient will be scheduled for regular follow-up appointments to monitor his renal function, manage his diabetes mellitus and hypertension, and assess his candidacy for renal transplantation.Disposition:The patient will be discharged with appropriate medications for his diabetes mellitus, hypertension, and symptom management. Referral to a nephrologist and transplant center will be initiated as per the patient’s preference.