LUPUS NEPHRITIS.pptx complete information

Lupus

1. PRESENTED BY : MEGHANA GANDEPALLI 4th Pharm D UNDER THE GUIDANCE OF : Dr. K Pavani A COMPLEX PUZZLE : EXPLORING THE LAYER OF SYSTEMIC LUPUS ERYTHEMATOUS Enikepadu , Vijayawada - 521108

2. TABLE OF CONTENTS 2 01 04 02 03 INTRODUCTION TO THE DISEASE CASE STUDY REFERENCES DISCUSSION

3. 3 WHAT IS SYSTEMIC LUPUS ERYTHEMATOUS…? With an unknown cause, the disease progresses by means of various physiological processes and attacks various organs of the body. The symptoms can range from a simple symptom of fever to a fatal conditions of multi organ failure to death. The prevalence of SLE includes females being more affected than males in the ratio of 9:1. Among the various complications arising from SLE, Lupus nephritis is considered as a significant and intricate concern. Systemic Lupus Erythematous is an “autoimmune condition” with Idiopathic etiology that effects different systems of the body .

4. 4 LUPUS NEPHRITIS : Lupus nephritis is the major and serious complications caused due to SLE. It occurs when lupus autoantibodies affect parts of the kidneys that filter out waste. Lupus nephritis is distinguished by the inflammatory process affecting the nephrons, resulting in the clinical manifestations such as hematuria, proteinuria, hypertension, edema, and in certain cases, renal insufficiency culminating in end-stage renal disease..

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6. CHIEF COMPLAINTS : A 24-year-old female was admitted in department of nephrology with chief complaints of facial puffiness accompanied by pitting type of pedal edema that had been present for ten days before her hospitalization and later developed as anasarca . In addition she had pyrexia since one day before admission. Along with these complaints she is also exhibiting arthralgia that is existing since 6 months. The patient is employed as a daily wage laborer in a poultry farm, specifically working as an egg collector . She also had an irregular menstruation . Furthermore, there was a complaint of nausea and vomiting occurring immediately after the consumption of food and water for the past seven days.

7. 7 PAST MEDICAL HISTORY Patient is a K/C/O : i. Typhoid ii. Dengue IgM + ve iii. HCV + ve

8. 8 PAST MEDICATION HISTORY Patient is under medication for the treatment of Typhoid and Dengue. FAMILY HISTORY No K/C/O CKD , HTN , DM , CAD or any other diseases. MEDICATION CLASS DURATION Paracetamol Analgesic & Antipyretic 2 weeks Ciprofloxacin Fluoroquinolone antibiotic 2 weeks

9. 9 LABORATORY INVESTIGATIONS A. COMPLETE BLOOD PICTURE : S.NO TEST LAB VALUE NORMAL RANGE UNITS 1. Hb% 3.0 12 - 15 g% 2 RBC 3.2 million 3.4 – 4.8 million Cells/ cumm 3. TOTAL WBC 3900 4,000 – 11,000 Cells/ cumm . 4. DIFFERENTIAL WBC : a. NEUTROPHILLS b. LYMPHOCYTES c. MONOCYTES d. EOSINOPHILLS 68 32 5 5 40 – 60 20 – 40 2 – 8 1 - 4 % % % % 3. PLATELET COUNT 1.5 lakhs 1,50,000 – 3,50,000 Cells/ cumm .

10. 10 B . RENAL FUNCTION TESTS : S.NO TEST LAB VALUE NORMAL VALUE UNITS 1. BLOOD UREA 35 17 – 43 mg/ dL 2. SERUM CREATININE 0.7 0.7 – 1.4 mg/ dL 3. SODIUM 137 134 - 144 mEq /L 4. POTASSIUM 3.2 3.5 – 5.0 mEq /L 5. CHLORINE 108 98 - 106 mEq /L C . 2D – ECHO : Mild Concentric LVH No RWMA of LV Minimal PE + Trivial MR / TR EF = 60 %

11. 11 D. LIVER FUNCTION TESTS : S.NO TEST LAB VALUE NORMAL VALUE UNITS 1. Total Bilirubin 0.3 0.3 – 1.2 mg/ dL 2. Direct Bilirubin 0.1 0.1 – 0.3 mg/ dL 3. Indirect Bilirubin 0.2 0.2 – 0.8 mg/ dL 4. ALT 22 30 - 65 IU/L 5. AST 35 15 - 37 IU/L 6. ALP 104 44 – 147 IU/L 7. Albumin 1.2 3.5 – 5.2 mg/ dL 8. Globulin 3.6 2.0 – 3.5 mg/ dL

12. 12 E. CLINICAL BIOCHEMISTRY (IRON PROFILE) : S.NO TEST LAB VALUE NORMAL VALUE UNITS 1. IRON (Fe ) 45.4 60 – 80 μ g/ dL 2. UNSATURATED IRON BINDING CAPACITY ( UIBC ) 124.1 155 – 300 μ g/ dL 3. TOTAL IRON BINDING CAPACITY (TIBC ) 169.5 250 – 425 μ g/ dL 4. TRANSFERRIN 118.53 250 – 380 μ g/ dL 5. IRON SATURATION 26.78 15 - 50 %

13. 13 F . ECG : The above image shows a borderline ECG S. NO TEST LAB VALUE NORMAL VALUE UNITS 1. PROTEINS 880 < 150 mg% 1800 G. 24 HOURS URINARY PROTEIN :

14. 14 H. ANTI NUCLEAR ANTIBODY TEST : S.NO TEST LAB VALUE NORMAL VALUE UNITS 1. ANTI NUCLEAR FACTOR ( ANF ) 37 < 20 _ I. USG ABDOMEN : LIVER : i . Altered ecotexture and coarsened appearance ii. IVC dialated . SPLEEN : normal in function B/L KIDNEYS : increased ecotexture Grade – II RPC changes CMD poorly maintained & PCS coarsened. B/L pleural efflusion and mild ascities noted

15. 15 PHARMACOTHERAPY PROVIDED S. NO DRUG DOSE ROA FREQ. START DATE AND END DATE GENERIC NAME BRAND NAME 1. HUMAN ALBUMIN ALBUMINAR - 25 20% IN 100m NS IV 4 TH hrly 01 – 02 – 24 to 06 – 02 – 24 2. FUROSEMIDE LASIX 20 mg IV BID 01 – 02 – 24 to 21 – 02 – 24 3. CEFTRIAXONE MONOCEF 1 g IV BID 01 – 02 – 24 to 08 – 02 – 24 4. IRON SUCROSE VENOFER 200 mg in 100 ml NS IV OD 01 – 02 – 24 to 06 – 02 – 24 5. TELMISARTAN TELMA 40 mg PO OD 01 – 02 – 24 to 21 – 02 – 24 6. ASPIRIN DISPIRIN 75 mg PO OD 01 – 02 – 24 to 08 – 02 – 24 7 ATORVASTATIN ATORVAS 10 mg PO H/S 01 – 02 – 24 to 21 – 02 – 24

16. 16 S. NO DRUG DOSE ROA FREQ. START DATE AND END DATE GENERIC NAME BRAND NAME 8. B COMPLEX NEUROBION FORTE -- PO OD 01 – 02 – 24 to 21 – 02 – 24 9. PANTOPRAZOLE PANTOP 40 mg IV OD 01 – 02 – 24 to 21 – 02 – 24 10. CHLOROQUINE HCQ 200 mg PO BID 03 – 02 – 24 to 08 – 02 – 24 11. TRAMADOL ULTRAM 5 mg IV BID 03 – 02 – 24 to 08 – 02 – 24 12. LMWH ENOXAPARIN 40 IU SC BID 03 – 02 – 24 to 21 – 02 – 24 13. PARACETAMOL PCM 500 mg PO TID 05 – 02 – 24 to 08 – 02 – 24 14. CEFIXIME PANCEF 200 mg PO BID 12 – 02 – 24 to 21 – 02 – 24 15. DOXOPHYLLINE DOXOVENT 100 mg PO BID 12 – 02 – 24 to 21 – 02 – 24

17. 17 S. NO DRUG DOSE ROA FREQ. START DATE AND END DATE GENERIC NAME BRAND NAME 16. AMBROXOL MUCICLAR 5 ml PO TID 12 – 02 – 24 to 21 – 02 – 24 17. PREDNISOLONE PEDIAPRED 20 mg PO OD 15 – 02 – 24 to 21 – 02 – 24 18. LEVOFLOXACIN LEVOFLOX 500 mg PO OD 09 – 02 – 24 to 21 – 02 – 24 19. IFA FEROGEN __ PO OD 12 – 02 – 24 to 21 – 02 – 24 20. ERYTHROPOEITIN INJ. EPO 4 UNITS SC BID 09 – 02 – 24 to 21 – 02 – 24

18. 18 DISCUSSION

19. 19 “ LUPUS NEPHRITIS ASSOCIATED WITH GROSS ANEMIA ” CONFIRMATORY DIAGNOSIS

20. 20 RATIONALITY OF THE PRESCRIPTION The given prescription was found to be “ IRRATIONAL ” S. NO TYPE OF INTERVENTION PROBLEM ACTION REQUIRED. 1. DRUG WITHOUT INDICATION TELMISARTAN Stop the medication as the BP levels are normal. 2. INDICATION WITHOUT DRUG Patient complains of redness and itching all over the body Anti histaminic agents can be prescribed and regularly monitored. 3. OVERDOSE Antibiotics Appropriate drug to be selected and given in right dose instead of multi drug therapy. 4. MEDICATION RELATED ERRORS Time of administering pantop Prescriber has to carefully observe the time of administration of drugs CLINICAL PHARMACIST INTERVENTION

21. 21 DRUG INTERACTIONS INTERACTION SEVERITY MECHANISM OF INTERACTION ACTION REQUIRED FUROSEMIDE - TELMISARTAN Major result in severe hypotension and deterioration in renal function, including renal failure. Dose adjustment is required. Regular monitoring is also necessary. 2. IRON SUCROSE - PANTOPRAZOLE Moderate Concurrent use of both can cause the reduction in the bioavailability of Iron. Dose adjustment and regular monitoring is requires. In an very risky condition , the iron supplements can be changed. When two or more of the drugs are prescribed to treat various conditions of the patient, some drugs may interact with each other and may produce effects which can range from minor to even fatal conditions. Some of the interactions that can be found in the patient’s treatment regimen includes :

22. 22 MONITORING PARAMETERS S. NO DRUG PARAMETER TO BE MONITORED 1. HCQ Albumin levels Heart Rate 2. ANTIBIOTICS Resistance to be checked. WBC count has to be checked too 4. HUMAN ALBUMIN Temperature pulse and respiratory rate blood pressure 5. ERYTHROPOEITIN Blood levels to be monitored regularly Monitoring certain parameters when following a treatment regimen is helpful to find out the risks that may trigger the patient’s condition even more.

23. 23 COUNSELLING THE PATIENT Strictly adhering to the treatment. Photo protection. Getting plenty of rest. Using prebiotics. Diet and nutrition Follow a DASH diet Physiotherapy. Vaccines.

24. 24 REFERENCES MICROMEDX - www.micromedexsolutions.com NATIONAL INSTITUTES OF HEALTH – https:// www.ncbi.nlm.nih.gov CIIMS MEDICAL DICTIONARY Drugs.com – https://www.drugs.com

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