Case Presentation on -CHRONIC
KIDNEY DISEASE with
HYPERTENSION
Reg. No : 19q0635
Pharm D 3rd year
Patient’s profile :-
IP No :202216856 Ward/ Unit :General medicine ward
DOA : 23-06-2022 DOD : 28-06-2022
Gender : Male Marital Status :Married
Age : 64years Education :
Weight (in kg) : Height (in cm) : Occupation : Farmer
SOCIAL HISTORY
Tobacco chewing : no
Tobacco smoking :no
Alcoholic : no
Any other relevant :
Reason for admission
Present complaints : C/O-Breathlessness since 8 days,fever since 5 days
Past medical history K/C/O CKD with HTYPERTENSION
Past medication history Amlodipine from 2years
Past surgical history Not known
Allergic history to any drugs Not known
Drug – drug interactions Not known
Drug – food interactions Not known
Physical parameters
VITAL SIGNS
Physical Examination +/- GENERAL EXAMINATION
Pallor + TEMPERATURE :Febrile
Icterus + BLOOD PRESSURE :160/70mmhg
Clubbing + PULSE RATE :88bpm
Cyanosis RESPIRATORY RATE : 18 cpm
SYSTEMIC EXAMINATION
Lymphadenopathy RS :B/L NVBS
Edema + CVS :S1 ,S2heard
CNS :Conscious oriented
ABD :Soft and non tender
ADVICE FOR TESTS- CBC, LFT,Serum
electrolytes,Urine,ECG,RBC,RFT & HBsAg
Provisional diagnosis:-
• Chronic kidney disease
Laboratory investigations
Lab test -CBC/HAEMATOLOGY TESTS Observed value Reference value
Hb 8.5g/dl M : 14 -17.5 g/dL
F : 12.3-15.3 g/dL
RBC M : 4.5-5.9 M/cumm
F : 4.1-5.1 M/cumm
WBC 4.4 - 11.3 /cumm
NEUTROPHILS 45 – 73%
LYMPHOCYTES 10% 20 – 40%
EOSINOPHILS 8% 0 – 4%
MONOCYTES 7% 2 – 8%
BASOPHILS 0 – 1%
PLATELETS 130,000/cumm 150,000 – 450,000/cumm
ESR M : 1 -15 mm/hr
F : 1- 20 mm/hr
PCV M : 42 – 50%
F : 36 – 45%
MCV 80 – 96 fL/cell
MCH 27 – 33 pg/cell
MCHC 33.4 – 35.5 g/dL
LAB TEST - BIOCHEMICAL Observed values Reference value
INVESTIGATON
BUN (BLOOD UREA - 40 8 – 23 mg/dL
NITROGEN)
SERUM CREATININE Audlt : 0.6 – 1.2 mg/dL
- 3.5
Children : 0.2 – 0.7 mg/dL
URINE ANALYSIS
COLOUR - YELLOW/ CLOUDY
ALBUMIN - 4–5 g/dL
URIC ACID 3mg/dl
Final diagnosis:-
CHRONIC KIDNEY DISEASE with
HYPERTENSION
Treatment chart
Medication name Dose/frequency Route D1 D2 D3 D4 Indication
O2 inhalation * * * *
Inj. Piperacillin + 4.5 gm(4.0g+0.5g)
IV * * * * ANTIBIOTIC
Tazobactum /TID
Tab. Paracetamol 500 mg / TID ORAL * * * * ANTIPYRETIC
INHALATIO
Neb Duolin Bronchodilator
N
Tab Acetyl
600 mg / BD ORAL * * Mucolytic agent
cysteine
INHALATIO
Neb Budesonide Bronchodilator
N
Tab. Nifedipine 10mg/ BD ORAL * * * * Calcium channel blocker
Antihypertensive
Inj.Furosemide 20mg/ BD IV * * * *
Pharmaceutical Care Plan
GOALS OF THE TREATMENT
• Short term goals • Long term goals
Relief of symptoms Normalize haemoglobin ,
To minimize disease eosinophil's
progression of CKD prevent complication
to improve quality of life
Monitoring Parameters
• Disease related • Drug related
complete blood count DRUG – DRUG
Haemoglobin ,eosinophil's interaction
Normalise BUN levels and Drug –food interactions
serum creatinine
Drug – Drug Interactions
s INTERACTING SEVERITY OF THE EFFECT MANAGEMENT
n DRUG INTERACTION
Major Mod. Minor
1 Furosemide + * Excretion of piptaz is Should not be
piptaz decreased when combined given in
with furosemide
combination
The risk of hypokalemia
can be increased when
2 Budesonide with * budesonide is combined
Furosemide with furosemide
Drug – FOOD Interactions
sn INTERACTING SEVERITY OF THE EFFECT MANAGEMENT
FOOD INTERACTION
Major Mod Minor
1 Food – Furosemide They reduce blood Should be taken
pressure, cause: before or after the
headache , meal .
dizziness , light
headedness,
fatigue and change
in heart rate
DRPS
1. Un treated indication : No
2. Improper drug selection : No
3. Sub therapeutic dose : No
4. Over dosage : No
5. Adverse drug reaction : No
6. Drug interactions : Yes
7. Failure to receive drug : No
8. Drug used without indication : No
9. Others if any : Yes
Patient Counselling
1. Disease: CKD it is a progressive irreversible deterioration of renal
function , it is characterized by anemia ,edema , hypertension
2. Medication: ANTIBIOTICS , ANTI HYPERTENSIVE
3. Life style modification :
Diet :1. DASH - Dietry approach to stop hypertension
2. Fluid intake should not exceed 1-5 to 2 litre per day
3. Controlled protein intake and low salt intake
4. Citrus fruits , including grapefruit , oranges , and lemons
may have powerful blood pressure lowering effects .
5. Keeping potassium low can assist in keeping the heart
healthy therefore , potassium rich foods may be limited or avoided
Thank you
