CASE STUDY ON CHRONIC KIDNEY DISEASE.pptx

Chronic Kidney Disease (CKD) is a progressive condition characterized by the gradual loss of kidney function over time. Here's a comprehensive explanation of CKD in four steps:

Causes and Risk Factors: CKD can result from various underlying conditions or risk factors that damage the kidneys' filtering units (nephrons) and impair their function. Common causes and risk factors include:

Diabetes: High blood sugar levels over time can damage the blood vessels in the kidneys.
Hypertension (high blood pressure): Elevated blood pressure can strain the kidneys' blood vessels and impair kidney function.
Glomerulonephritis: Inflammation of the kidney's filtering units can lead to scarring and loss of function.
Polycystic kidney disease: Inherited disorder characterized by the growth of cysts in the kidneys, leading to kidney enlargement and loss of function.
Prolonged obstruction of the urinary tract: Conditions such as kidney stones or an enlarged prostate can obstruct urine flow, leading to kidney damage.
Autoimmune diseases: Conditions like lupus or vasculitis can cause inflammation and damage to the kidneys.
Certain medications: Long-term use of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or some antibiotics, can contribute to kidney damage.
Stages and Progression: CKD is typically classified into five stages based on the estimated glomerular filtration rate (eGFR), which measures how well the kidneys are filtering waste from the blood. The stages are as follows:

Stage 1: Kidney damage with normal or high eGFR (≥90 mL/min/1.73 m²)
Stage 2: Mild decrease in eGFR (60-89 mL/min/1.73 m²)
Stage 3: Moderate decrease in eGFR (30-59 mL/min/1.73 m²)
Stage 4: Severe decrease in eGFR (15-29 mL/min/1.73 m²)
Stage 5: Kidney failure (eGFR <15 mL/min/1.73 m² or dialysis)
CKD progresses slowly over time, and symptoms may not be apparent until the later stages when significant kidney damage has occurred.

Symptoms and Complications: In the early stages, CKD may be asymptomatic, and symptoms may only become evident as kidney function declines. Common symptoms and complications of CKD include:

Fatigue and weakness
Swelling of the legs, ankles, or feet (edema)
Shortness of breath
Nausea and vomiting
Itching
Loss of appetite
Muscle cramps
Difficulty concentrating
Electrolyte imbalances (e.g., high potassium levels)
Bone disease (e.g., osteoporosis)
Anemia
Complications of advanced CKD include cardiovascular disease, fluid overload, electrolyte imbalances, and kidney failure requiring dialysis or kidney transplantation.

Management and Treatment: The management of CKD aims to slow the progression of the disease, manage symptoms, and prevent complications. Treatment may involve:

Lifestyle modifications: Maintaining a healthy diet low in salt, potassium, and phosphorus, exercising regularly, maintaining a healthy weight, and quitting smoking.
Blood pressure control: Medications such as ACE inhibitors

1. BY, SRIRAM THIRUNAVUKKARASU, PHARM.D III RD YEAR, 380020514525, PGP COLLEGE OF PHARMACEUTICAL SCIENCE AND RESEARCH INSTITUTE, NAMAKKAL. CASE STUDY ON CHRONIC KIDNEY DISEASE

2. CASE SUMMARY A 73 years old female patient was admitted in hospital on 11/07/2023 with chief complaint of sudden onset of fever with chills and rigors associated with decreased urine output. Now she is admitted for further evaluation and treatment. The patient has past medical history of Diabetes mellitus, Systemic hypertension and Chronic kidney injury. The patient has past medication history of Inj.Human mixtard , T. Taurine + Acetyl cysteine, T. Rosuvastatin, T. Torsemide and T. Alprazolam. The patient was diagnosed to be Cystitis, Diabetic nephropathy and Acute kidney disease on Chronic kidney disease. She has no social history . She has no known food or drug allergies. Inj. Meropenem, Inj. Paracetamol, Inj. Pantoprazole, Inj. Ondansetron, Inj. Human mixtard , T. Taurine + Acetyl cysteine, T. Rosuvastatin, T. Torsemide, T. Levofloxacin and T. Alprazolam were the drugs given to the patient during hospitalization. She was discharged on 14.7.2023.

3. CHRONIC KIDNEY DISEASE DEFINITION CKD is a condition in which the kidneys are damaged and cannot filter blood as well as they should. Because of this, excess fluid and waste from blood remain in the body and may cause other health problems, such as heart disease and stroke.

4. PATHOPHYSIOLOGY

5. SOAP ANALYSIS

6. SUBJECTIVE A 73 years old female patient was admitted in hospital on 11/07/2023 with chief complaint of sudden onset of fever with chills and rigors associated with decreased urine output. Now she is admitted for further evaluation and treatment. The patient has past medical history of Diabetes mellitus, Systemic hypertension and Chronic kidney disease. The patient has past medication history of Inj.Human mixtard , T. Taurine + Acetyl cysteine, T. Rosuvastatin, T. Torasemide and T. Alprazolam. The patient was diagnosed to be Cystitis, Diabetic nephropathy and Acute kidney disease on Chronic kidney disease. She has no social history . She has no known food or drug allergies.

7. The patient was conscious, oriented and febrile. No head injury Eye movement normal CVS - S 1 S 2 Normal RS - B/L AE(+) CNS – NFND. GIT-P/A - Soft. The patient have peripheral edema and distended abdomen. OBJECTIVE On Physical Examination,

8. S. NO PARAMETERS DAY 1 DAY 2 DAY 3 DAY 4 NORMAL RANGE 1. TEMPERATURE 100 99 98 97.5 97.2-98.8 ֯ F 2. BLOOD PRESSURE 100/70 110/50 130/75 120/90 120/80 mmHg 3. PULSE RATE 64 82 80 90 60-100 Beats/min 4. RESPIRATORY RATE 18 16 20 18 12-16 breaths/ min 5. SPO 2 94 98 96 96 95-100% VITAL SIGNS:

9. LABORATORY TEST: LAB INVESTIGATION 11/7/23 NORMAL VALUES FULL BLOOD COUNT Hb 10.4 12-15 g/dL RBC 4.01 4-5.65 million cells/cu.mm WBC 11930 4000-11300 cells/cu.mm PCV 31.06 40-52% Platelet 149000 150000 - 450000 cells/µl LIPID PROFILE T. Cholesterol 175.9 0-200 mg/dL TG 92.8 40-200 mg/dL HDL 47 >50 mg/dL LDL 110.34 <100 mg/dL VLDL 18.56 3-20 mg/dL

10. PARAMETERS 11/7 12/7 13/7 14/7 NORMAL RANGE UREA 68.9 57 41.1 40 10-50mg/dL SERUM CREATININE 2.39 1.75 1.54 1.03 0.7-1.2mg/dL SODIUM 132.6 131.0 132.0 133.6 133-145mEq/L POTASSIUM 4.9 5.1 4.1 3.4 3.3-5.1mEq/L RENAL PROFILE PARAMETER 11/7 12/7 13/7 14/7 NORMAL RANGE FBS 82 81 86 103 60-100mg/dL OTHERS

11. URINE ANALYSIS VALUES NORMAL RANGE Pus cells 80-100 0-5 cells/hpf RBC 30-40 0 - 3 cells/hpf Epithelial cells 2-3 15 - 20 cells/ hpf Specific Test USG Abdomen and Pelvis Impressions Cystitis Mild spleenomegaly

12. PLAN Goals Of Therapy, To treat the acute kidney injury via supportive care and antibiotic therapy for infection. To screen for increase Hemoglobin content naturally or to preceed with blood transfusion. To retain the normal urine output. To treat fever. To treat edema.

13. THERAPHY :- DRUG DOSE ROA FREQUENCY 11/7 12/7 13/7 14/7 Inj. Meropenem 1 g IV TDS Inj.Paracetamol 1 g IV OD Inj. Pantoprazole 40 mg IV OD Inj. Human mixtard 10U-0-6U SC BD Inj. Ondansetron 8 mg IV TDS T. Acetylcysteine + Taurine 500 + 150 mg Oral OD T. Rosuvastatin 10 mg Oral OD T. Torsemide 10 mg Oral OD T. Levofloxacin 500 mg oral OD T. Alprazolam 0.5 mg Oral OD

14. DRUG-DRUG INTERACTION DRUG – 1 DRUG – 2 INTERACTION Levofloxacin Alprazolam levofloxacin increases levels of alprazolam by decreasing metabolism. Levofloxacin Ondansetron levofloxacin and ondansetron both increase QTc interval. Avoid or Use Alternate Drug levofloxacin Human mixtard levofloxacin increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia.

15. DISCHARGE MEDICATION S.NO DRUG DOSE FREQUENCY 1. Human Mixtard 30/70 BD( 10U-0-6U ) 2. T. Faropenem 200 mg BD(1-0-1) 3. T. Acetylcysteine+ Taurine 650mg OD(1-0-0) 4. T. Rosuvastatin 10 mg OD(0-0-1) 5. T. Torsemide 10 mg OD(1-0-0) 6. Cap.Esomeprazole 40 mg BD(1-0-1) 7. T. Alprazolam 0.5 mg OD(0-0-1)

16. DRUG BASED COUNSELLING Take the medication properly in a correct dose and time properly. Do inform the physician if you have any adverse effect. T. Esomeprazole should be taken before meal time. T. Alprazolam should be taken at the night time. DISEASE BASED COUNSELLING CKD is a condition in which the kidneys are damaged and cannot filter blood as well as they should. AKD is a condition of sudden deline function of kidney on your chronic kidey disease. The fluid accumulation in stomach area and legs are the symptoms of this disease. PATIENT COUNSELLING

17. DIET BASED COUNSELLING Avoid junk foods and high fatty. Follow a no carbohydrate diabetic diet. Decrease your salt intake. Follow a low hydrated diet with good protein and fibre intake. Avoid Ice creams and other outside foods. Its better to have steamed vegetable without cooking it or spicing up with spices and oil. LIFESTYLE BASED COUNSELLING Have enough rest. Sleep well at night and avoid overthinking. Be in a stress free environment. Don't put your legs fall on gravity for longer time. Sleep on one side rather than sleeping straight.

18. PHARMACIST INTERVENTION From the medication chart analysis, it was found that a serious interaction persist that needs to be taken measure that levofloxacin and ondansetron both increase QT c interval as she is proned to have some cardiac issues on her past medical history. The edematous symptoms persists yet. So she can be given with either Spironolactone and Furosemide or Spironolactone and Toresemide which is the most widely used combination for edema.

19. THANK YOU