Chronic Kidney Disease: A Case Presentation On

A CASE PRESENTATION ON
CHRONIC KIDNEY DISEASE

Presented by AMENA HUSNA
170718883001
Pharm.D PB Ist yr
Under the guidance of

Mr.MOHD FAREEDULLAH
Associate Professor
Departmant of Pharmacy Practice
Deccan School of Pharmacy
DEFINITION
• Chronic kidney disease(CKD) is defined as abnormalities in kidney structure or
function, present for 3 months or longer, with implications for health, and
reduction in the glomerular filtration rate (GFR) and/or urinary abnormalities.
• Structural abnormalities include albuminuria of more than 30 mg/day, presence
of hematuria or red cell casts in urine sediment, electrolyte and other
abnormalities due to tubular disorders, abnormalities detected by histology,
structural abnormalities detected by imaging, or history of kidney transplant.
• CKD stage 5, occurs when the GFR falls below 15 mL/min/1.73 m2 (<0.14
mL/s/m2).
EPIDEMIOLOGY
 CKD has been described as a silent epidemic and is a worldwide public health
problem. The prevalence of CKD is at least 5% of the adult population (in US)
when using a serum creatinine concentration of greater than 1.2 to 1.5 mg/dL as
the definition.
STAGES OF CHRONIC KIDNEY DISEASE
PATHOPHYSIOLOGY
The various etiologic factors actually damage the kidney in a heterogenous manner.
• The structural lesion in diabetic nephropathy - glomerular mesangial expansion.
• In hypertensive nephrosclerosis - hyalinosis of the kidney’s arterioles
• In polycystic kidney disease - the development and growth of renal cysts.
A variety of morphologic glomerular changes have been noted to occur. The majority of progressive
nephropathies share a final common pathway to irreversible renal parenchymal damage and ESKD.
The key elements of this pathway are:
(1) loss of nephron mass;
(2) glomerular capillary hypertension; and
(3) proteinuria.
These risk factors results in loss of nephron mass,
then nephrons hypertrophy, development of glomerular
hypertension, systemic arterial HTN, and this leads to
high intraglomerular capillary pressure, which impairs
the size selective function of the glomerular
permeability barrier, and results in albuminuria and
proteinuria.
• Loss of nephron units - Reduced GFR.
SIGNS & SYMPTOMS
Cardiovascular: Left ventricular hypertrophy, Congestive heart failure, dyslipidemia,
palpitations, arrhythmias, elevated creatine kinase-myocardial bound (CK-MB) and
creatine kinase (CK), worsening hypertension, and edema.
Musculoskeletal: Cramping and muscle pain.
Neuropsychiatric: Depression, anxiety, impaired mental cognition, fatigue.
Gastrointestinal: Gastroesophageal reflux disease, constipation, GI bleeding, nausea, and
vomiting.
Symptoms are generally absent in CKD Stages 1 and 2, and may be minimal during
Stages 3 and 4. Stage 5 CKD symptoms include : Pruritus, Dysgeusia, nausea, vomiting,
and bleeding abnormalities.
Symptoms associated with anemia include : cold intolerance, shortness of breath,
decreased appetite and fatigue.
DIAGNOSIS
• Blood tests: Blood creatinine, uric acid, urea, sodium, potassium, chlorides, calcium,
phosphorous.
• Urine tests: albumin, sugar,
• Imaging tests: ultrasound to assess your kidneys' structure and size.
• Biopsy : In biopsy a sample of kidney tissue is removed.
SOAP FORMAT
SUBJECTIVE
 A 69 years old patient was admitted in Nephrology department
on 10th September, with chief complaints of shortness of breath,
generalized weakness, lack of appetite, fever constipation and
pedel edema.
 PAST MEDICATION HISTORY:
The patient is suffering from Hypertension , since 10 years( on
medication: Amlodipine 5mg)
PERSONAL HISTORY:
The patient was occasional Alcoholic.

OBJECTIVE DATA
O/E the patient has edema, weakness, shortness of breath since 4-5 days.
• The following tests are advised by Physician.
• CBP
• CUE
• RFT
• LFT
• ECG
• Blood grouping
• USG Abdomen
• CRP test
ABNORMAL VALUES
FINAL DIAGNOSIS
CHRONIC KIDNEY DISEASE STAGE V

ASSESMENT
PROBLEM 1: Shortness of breath
MEDICATION: Deriphylin 150 mg (Theophyline)
PROBLEM 2: Atrial fibrillation
MEDICATION: Cordarone 100mg (Amiodarone hcl)
PROBLEM 3: Occlusive thrombosis/mild artherosclerosis
MEDICATION: Ecosprin 150 mg (Asprin)
PROBLEM 4: Weakness
MEDICATION: Tab.FOL 5mg (Folic acid)
Problem 5: Nausea and vomiting
MEDICATION: Tab.Zofer 4mg (Ondensetron)
PROBLEM 6: Hypertension
MEDICATION: Tab. TEL 40mg (Telmisartan)
PROBLEM 7: Increased CRP levels
MEDICATION: Tab.Orpenem 200mg (feropenum sod)
PROBLEM 8: Increased creatinine level , edema due to CKD
MEDICATION THERAPY: Haemodialysis alternate day
DRUGS GENERICS STRENGTH FREQUENCY
Tab.Pan Pantoprazole 40 mg OD
Tab. Zofer Ondansetron 4 mg BD
Tab. Cardone Amiodarone 100 mg BD
Tab. FOL Folic acid 5 mg OD
T. Deriphyllin Theophillin 150 mg BD
T. Ecosprin Asprin 325 mg BD
T.Orpenum Faropenum 200 mg BD
T. TEL Telmisartan 40 mg OD
DAY NOTES
DAY 1:
Temperature: 100 ֠ F , BP: 130/80 mmHg, Pulse: 98 b/min, RR: 26/min
Medication: Tab. PAN 40 mg(Pantoprazole)
Tab. Zofer(4mg) Ondensetron
Tab. Cardorone 100mg (Amiodorone hcl)
Tab.FOL 5mg (Folic acid)
Tab .Deriphylin 150 mg (Theophyline)
Tab. Ecosprin 150 mg (Asprin)
Tab. TEL 40 mg ( temisartan)
HAEMODIALYSIS (AV Fistula placement)
DAY 2: Temperature: 99 ֠ F , BP: 130/80mmHg, Pulse : 80 b/min, CRP: 48 mg/dl,
no fresh complaints.
Medication: Add Tab .Orpenum 200 mg( Feropenum)
DAY 3: Temperature: 98 ֠ F, pedel edema, BP : 120/80 mmHg, No fresh complaints.
Medication: continue same treatment, HAEMODIALYSIS.
DAY 4: Temperature: 98 ֠ F, , BP : 120/80 mmHg, No fresh complaints.
Medication: continue same treatment.
PATIENT COUNSELLING
Regarding the disease:
 Stage V chronic kidney disease causes severe complications such as Anemia,
metabolic bone disorder etc. , to pevent such complications pateint is adviced to take
food rich in Iron to maintain the Haemoglolobin levels (8.0 gm/dl) and also take
calcium rich foods.
 Maintainance of normal blood pressure is necessary to prevent worsening of the
disease.
Regarding the medications:
 Tab. PAN should be taken 30 min before food.
 Tab.Deriphyllin : if the dose is missed take it as soon as you remember, do not double
the dose to make up the missed dose.
 Cordarone: avoid grape fruit juice , it increases plasma level of drug by inhibiting its
metabolsim.
 Haemodialysis should be performed every alternate days.
Regarding lifestyle modifications
 Dietary protein and phosphorus restriction (protein intake of 0.6 g/kg per day)
was significantly associated with a decreased rate of progressive renal disease,
so the pateints are bieng counselled for low protein diet to prevent protenuria.
Reduction of blood pressure is key to decreasing cardiovascular and renal
sequelae. Maintanance of blood pressure by antihypertensives and low salt
intake is necessary.
Restriction of dietary fluid intake and drink very less water.
Prevention of hyperlipedimia is necessary in ckd patients, hence adviced to
avoid high fat meals.
Cessation of Alcohol.
Regular serum creatinine , urea check up.
PHARMACIST’S INTERVENTION
• The pateint was suffering from fever and constipation for which no medications
were prescribed.
Drug interactions:
• Amiodarone + Theophyline
Monitor :Amiodarone decreases the hepatic metabolism theophiline, increased
theophiline concentration may increaes the risk of developing theophiline toxicity.
Management : Decrease the theophiline dose and change the dosing frequency and
time administration of both the drugs to prevent their interaction.
• Theophilline+ Pantoprazole
Pantoprazole increases theophilline absorption and may cause its toxicity
Management : Both drugs should not be given concurrently or decrease the dose of
theophilline.
• Asprin + Pantoprazole
Co administration of asprin with PPIs may decrease the oral bioavailability of
asprin.
Management : Both dugs should not be administered concurrently.

Chronic Kidney Disease: A Case Presentation On

Uploaded by

Copyright:

Available Formats

Chronic Kidney Disease: A Case Presentation On

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Chronic Kidney Disease: A Case Presentation On

Uploaded by

Copyright:

Available Formats

A CASE PRESENTATION ON

CHRONIC KIDNEY DISEASE

Under the guidance of

The patient was occasional Alcoholic.

CHRONIC KIDNEY DISEASE STAGE V

Tab. Zofer Ondansetron 4 mg BD

Tab. Cardone Amiodarone 100 mg BD

Tab. FOL Folic acid 5 mg OD

T. Deriphyllin Theophillin 150 mg BD

T. Ecosprin Asprin 325 mg BD

T.Orpenum Faropenum 200 mg BD

You might also like