Case presentation on renal caliculi

renal caliculi , types , drug therapy , adverse reactins and mechanism of drugs , frequency and patient counseling

1. case presentation on Right ureteric caliculi T . Sai swapna II/VI Pharm . D Nirmala college of pharmacy Department of pharmacy practice

2. Case summary; A female patient of age 61 years suffering from right lion pain since few years burning sensation , decreased micturition , past history includes oliguria , diabetes , sciatica & lumbar spondylitis , sleep and appetite was found to be normal Based on lab parameters and other tests the patient diagnosed with right ureteric caliculus . The patient was normalised at the time of discharge and prescribed with medications The case was evaluated in the SOAP format

3. Subjective data ; A female patient of age 61 years suffering from pain , burning sensation , past history includes oliguria , diabetis , sciatica , lumbar spondylitis . His sleep and appetite was found to be normal . Bowel was found to be regular .

4. Objective data ; Physical examination; Pulse- 84 b/m BP – 110/70 mm of hg Temperature – 98 degrees F RR – 26 b/m PICKLE – Normal Systemic examination; CVS – s1 s2 + CNS - NFND P/A –soft and non tender RS – BAE +

5. Lab tests ; RBC –4.48 million c/cubic mm (4.2-5.6 ) WBC – 10,000 c / cubic mm (4,000-10,000 ) Hb – 11.6g/dl (14-18 ) Heamotocrit – 35.2% ( 34 – 47 ) MCV – 78.6FL (78-98) MCH – 25.8pg (27-35) MCHC – 32.8g/dl (31-37) Platlets – 2,36,000 c/cub.mm (1,40,000-4,50,000) RDW – 14% (11-14.5) Serum creatinine – 1 .30 mg/dl (0.6 – 1.2 )

6. Lab tests; GLUCOSE – fasting - 114mg/dl random - 206 mg/dl Others ; CT scan of kidney and UB - Impression ; large proximal uteric calculus producing moderate hydronephrosis . X – ray of K & UB – Impression ; right proximal ureteric calculi Chest X ray – No obvious abnormalities ECHO – Normal cardiac chambers

7. Others ; Hepatitis b & c antigen ; negative

8. Assessment ; Based on the subjective and objective data the final diagnosis as follows RIGHT URETERIC CALICULI DEFINITION ; Mineral mass in ureterus ETIOLOGY ; Several reasons not particular . RISK FACTORS; Low fluid intake Increase Calcium absorption into intestine Gout HTN Hyperparathyrodism Colitis

9. Types ;

10. Types; Calcium oxalate crystals ; common Styruvite crystala ; mostly in women Uric acid crystals; more in men Cystine crystals ; rare

11. Pathophysiology;

12. CLINICAL MANIFESTATIONS ;

13. Signs and symptoms ; Severe pain in the back and side of abdomen Pain during micturition Reddish urine Vomiting Fever and chills if any UT infection Urination frequently Heamaturia Cloudy urine

14. Plan ; Goals; To decrease signs and symptoms To decrease disease progression To decrease further complications involved SURGERIES includes percutaneous nephrolithotomy , extra corporeal shock wave lithotripsy (ESWL) Recommended for PCNL right and ESWL right

15. Management ;

16. Drug chat ; s.no Brand name Generic name Dose ROA Frequency Duration of therapy 1 . Inj .magnex forte Cefperazone &salbactum 1 gm&500mg IV BID 3 Days 2 . Inj. Tranexa Tranexamic acid 100mg/ml IV BID 3 Days 3 . Inj . Aciphex Rabeprazole 20mg IV OD 3 Days 4 . Inj . Ultram Tramadol 50mg IV BID 3 Days

17. s.no Drug MOA Indication ADR’S MP 1 . Inj . Magnex forte - Cell wall synthesis To treat infection Rash , fever urticaria , liver enzymes increase Blood profile ,liver enzymes , creatinine 2. Inj. Tranexa Inhibit fibrinolysis and decrease inflammation To treat renal impairment Nausea , vomiting's, hypotension, diarrheoa BP, blood profile, kidney functioning 3. Inj. Aciphex - Gastric secretion prophylaxis Headache, constipation, pain, anemia Blood profile,ECG,na&K levels 4 . Inj. Ultram Bind to opiod receptors and - pain To decrease pain Constipation, nausea , dizziness, anxiety Patient conditions like anxiety

18. DRUG INTERACTIONS ; No drug drug interactions

19. Patient counseling ; About disease ; It is due to the mineral and salt deposition in ureter These block the urine passage through ureter Renal insuffiency occurs and creatinine levels are abnormal

20. Life style modifications ;

21. Life style modifications ;

22. Diet therapy; To reduce oxalate crystals ; Aviod nuts , rhubarb, spinach , wheat To reduce sodium crystals ; Aviod salt and meat and packed fast foods Limit animal protein ; eggs and meat To reduce uric acid crystals; Aviod beef , chicken , eggs , fish To reduce cysteine stones ; Drink water

23. THANK YOU