CASE PRESENTATION WHICH INCLUDES PHARMACEUTICAL ISSUES

1. CHRONIC KIDNEY
DISEASE, LCDD AND
HYPERTENSION
By
Amarnath Mullapudi
NIPER Mohali
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2. CHIEF COMPLAINTS
• Generalized weakness x 6 months
• Shortness of breath x 6 months
• Fever x 3 weeks
• Edema of lower limbs x 3 months
2

3. PATIENT DETAILS
• Age : 48 years
• Sex : Male
• Weight : 58 kgs
• BP : 190/84 mmHg
• HR : 74 beats/minute
• RR : 20/minute
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4. LAB INVESTIGATIONS
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5. LAB INVESTIGATION-I
Parameter Normal
Range
Days
Na+ 136-145
mEq/L
D1 D2 D3 D4
134 136 136 142
D5 D6 D7 D8
139 136 134 138
K+
3.5-5
mEq/L
D1 D2 D3 D4
4.4 4.2 4.9 4.2
D5 D6 D7 D8
4.6 4.2 4.6 4.9
5

6. LAB INVESTIGATION-II
Parameter Normal Range Days
Cl- 98-106
mEq/L
D1 D2 D3 D4
98 98.8 99.6 102
D5 D6 D7 D8
100 98 102.3 97.5
Urea 15-40
mg/dL
D1 D2 D3 D4
101.5 86.4 68.8 101
D5 D6 D7 D8
68.8 101 69 113.5 6

7. LAB INVESTIGATION-III
Parameter Normal
Range
Days
Creatinine 0.5-1.3
mg/dL
D5 D6 D7 D8
5.5 6.6 5.60 7.36
D5 D6 D7 D8
4.87 6.8 7.9 8.09
Bilirubin 0.3-1.3
mg/dL
D1 D2 D3 D4
0.8 0.4 0.5 0.6
D5 D6 D7 D8
0.7 01 0.2 0.2 7

8. LAB INVESTIGATION -IV
Parameter Normal
Range
Days
Ca++ 8.6-10.2
mg/dL
D1 D2 D3 D4
12.7 11.2 9.6 7.8
D5
6.6
D6
10.47
D7
11.4
D8
9.8
Phosphate 2.5-4.5
mg/dL
D1 D2 D3 D4
6.0 6.0 5.2 5.7
D5 D6 D7 D8
5.7 4.3 8.0 7.8 8

9. LAB INVESTIGATION-V
Parameter Normal
Range
Days
Hb 13-18/dL D1 D2 D3 D4
8.5 9.1 9.3 10.2
D5 D6 D7 D8
11.1 9.8 8.7 10.5
TLC
4-11 x
103/micro
litre
D1 D2 D3 D4
7.2 9.5 8.9 7.8
D5 D6 D7 D8
7.9 8.2 8.0 7.8 9

10. DIAGNOSTIC TESTS
• Biopsy of Kidney
• Serum Protein Electrophoresis (SPEP)
• Urine Protein Electrophoresis (UPEP)
• Immunofixation (IFE)
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11. DIAGNOSIS
• Chronic Kidney Disease (CKD)
• Light Chain Deposition Disease (LCDD)
• Hypertension
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12. Medication Chart
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13. Drugs Dose ROA Frequency Days
Metoprolol 50mg PO BD D1-D8
Prazosin 5mg PO HS D1-D8
Amlodipine 10mg PO TDS D1-D8
Torsemide 100mg PO TDS D1-D8
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14. Drugs Dose ROA Frequenc
y
Days
Clonidine 0.1mg PO OD D1-D8
Sevelamer 800mg PO TDS D1-D8
Vancomycin 1000mg IV EVERY 72
HOURS
D3&D6
Erythropoietin 10,000
iu
SC WEEKLY D1&D8
Pantoprazole 40mg IV OD D1-D8
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15. Pharmaceutical Issues
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16. Drug Interactions
Metoprolol x Clonidine
Concurrent use of Metoprolol and Clonidine
may result in increased risk of Sinus
Bradycardia.
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17. Drug Interactions
Metoprolol x Prazosin
Concurrent use of Alpha-1 adrenergic blockers
may result in exaggerated Hypertensive
response.
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18. MANAGEMENT
• Heart rate and B.P should be monitored when
clonidine and metoprolol are administered.
Metoprolol should be withdrawn before the
gradual withdrawal of clonidine to avoid
rebound hypertension.
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19. Advice as Pharmacist…
• Counseling should be provided to the patient
about sudden discontinuation of clonidine.
• Skipped dose of clonidine should be ignored &
continue the regular dose. Next dose should be
within 4 hours.
.
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20. SUMMARY
• A 48 year old male was admitted to the
hospital with the following complaints:-
• Generalized weakness, SOB and fever.
Complaint of edema in lower limbs
• He was diagnosed with Chronic kidney
disease, LCDD and Hypertension.
• He was administered with Beta blockers, alpha
blockers, diuretics ,erythropoietin and
sevelamer .
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21. Summary cont…
• Vancomycin was administered to manage
catheter induced infection.
• The patient had been undergoing
haemodialysis for the management of Chronic
Kidney Disease.
21

22. REFRENCES
• Harrison’s Principle of Internal Medicine, 18th
Ed.
• Bailey RR & Neale TJ: Rapid clonidine
withdrawal with blood pressure overshoot
exaggerated by beta-blockade. Br Med J 1976;
1:942-943.
• Micromedex
• Light chain deposition disease: novel
biological insightsand treatment advances
V. H. JIMENEZ-ZEPEDA
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