Renal failure case presentation

Case presentation for PHARM D students on the topic Chronic Renal Parenchymal disease .

1. PHARMACOTHERAPEUTICS CASE PRESENTATION RAJNANDINI SINGHA III PHARM D

2. CASE STUDY ON CHRONIC RENAL PARENCHYMAL DISEASE

3. SUBJECTIVE A 65 year old Male patient was admitted in PMCH on 13/7/2017 with the complaints of abdominal pain for 10 days.

4. HISTORY OF PRESENT ILLNESS H/O Abdominal pain, pricking type, more during at night. H/O swelling, Difficulty in breathing H/O Abnormal urine colour , Frequent urination at night. H/O LOA, LOW , Fatigue, fever No H/O Abdominal distension. H/O Muscle cramp.

5. PAST HISTORY Diabetes mellitus for past 20 yrs. Hypertension for past 25 yrs. Taking medication such as STATINS

6. PERSONAL HISTORY Diet: Mixed. Alcohol for past 40 yrs.

7. GENERAL EXAMINATION Patient conscious, oriented BP :160/70 mmHg PR :79 bpm

8. SYSTEMIC EXAMINATION CVS – S 1 S 2 Heard RS - B/L AE+ CNS – NFND P/A - Soft

9. OBJECTIVE INVESTIGATION CHART NAME OF INVESTIGATION OBSERVED VALUE NORMAL VALUE WBC 6.2 x10 9 /L 4.5-10.5 ×10 9 /L RBC 4.26x10 12 /L 3.8-5.9 × 10 12 /L HAEMOGLOBIN 9.5g/dl 12-14g/dl PLATELETS 173.0  10 9 /L 130-400 10 9 /L L/M/G 2.5/1.5/11.0 10 9 /L MCV 92.9 FL 80-100FL HCT 23.2% 35-50% MCH 27.6pg 27- 34pg

10. MCHC 29.7g/dl 32-36g/dl ESR 38mm/hr 0-20mm/hr BIOCHEMISTRY RBS 67 mg/dl Up to 140 mg/dl BLOOD UREA 46 mg/dl 10-40 mg/dl SERUM CREATININE 2.2mg/dl 0.6-1.3 mg/dl GFR 14ml/min SERUM PHOSPHATE 7.5 mg/dl 2.5-4.5 mg/dl URINE ANALYSIS COLOUR Brown REACTION Acidic ALBUMIN +

11. OTHER INVESTIGATION ECG- sinus rhythm inferior myocardial infraction. X-RAY –Left lung lower lobe consolidations , Bilateral infiltrates .

12. USG ABDOMEN & PELVIS: B/L Chronic renal parenchymal diseases. B/L Small renal cortical cyst.

13. Myocardial infraction

14. Left lower lung consolidation

15. Bilateral infiltrates

16. Renal cortical cyst

17. ASSESMENT FINAL DIAGNOSIS Chronic Renal parenchymal disease.

18. DRUG CHART DRUG GENERIC NAME DOSE ROUTE FREQ 3 4 5 6 7 Inj.taxim cefotaxime 2gm IV bd √ √ √ √ √ T.RANTAC Ranitidine 150mg oral od √ √ √ √ √ T.BCT Vitamin B+ Vitamin C Oral bd √ √ √ √ √ T. Dolo Paracetamol 650mg oral bd √ √ √ √ √ Inj. Deri Theophylline+Etophylline 20mg IV bd √ √ √ √ √ T.LASIX FUROSEMIDE 40mg oral bd √ √ √ √ √ inj . Procrit Erythropoietin 100mg IV od √ √ √ T.Cozar Losartan 50mg oral od √ √ √ √ √

19. DRUG GENERIC NAME DOSE ROUTE FREQ 3 4 5 6 7 T.calcium carbonate Calcium carbonate 2gm oral Od √ √ √ √ √ T.Hamengeol Propranolol 40mg oral Od √ √ √ √ √ T.Januvia sitagliptin 100mg oral Od √ √ √ √ √ T. Flovas Pitavastatin 2mg oral Od √ √ √ √ √

20. DISCHARGE SUMMARY The patient was discharged on 8/07/17 DISCHARGE ADVICE T . Lasix OD T . Rantac OD T.DERI 150 mg 1-0-1 (10) T.Losartan OD T.Calcium carbonate OD T.BCT BD T . Sitagliptin od T. Pitavastatin od Review after 1 week

21. PLAN DISEASE BASED COUNSELLING Blood purification must be done once to remove the metabolic waste and toxins. Such as: Dialysis Blood perfusion plasma exchange Hypertension: BP should be controlled. Low intakes of salt DIABETES MELLITUS : Control sugar levels. Obesity can progress to CKD

22. Renal cortical cyst: Avoiding spicy foods, salted, leftovers, polluted foods, greasy foods, stimulating foods as chocolates, coffee, crabs, etc. Avoid smoking , drinking alcohol. Nicotine and alcohol can accelerate the growth of cysts, elevate your blood pressure and worsen damages on the kidneys.

23. Diet based counseling Low protein diet, Low Salt Diet ,Limited intake of potassium (milk or mil k products, honeydew, legumes, nuts, potatoes, seeds, tomato products and yogurt.) Limited intake of phosphorous( meats, whole grain breads, cola beverages, cheese, dried beans , peanut butter, dairy products and chocolate). Avoiding unhealthy fats.

24. DRUG BASED COUNSELLING Ranitidine should be administered 30 minutes before consuming food Furosemide should be administered 1 hr before consuming food or 2 hrs after food. Calcium carbonate should be taken 5 mins before the food as it causes faster absorbtion of calicium carbonate.

25. PHARMACIST INTERVENTION The patient has very low RBS So the diabetic profile should be monitored again and the drug dose should be adjusted. Beta blockers are sometime contraindicated in patient having difficulties in breathing, so it can be switch to other classes of drugs such as ACE INHIBITORS and ARB drugs.

26. THANK YOU