CKD refers to all 5 stages of kidney damage, from very mild damage in stage 1 to complete kidney failure in stage 5

1. CASE PRESENTATION ON
CHRONIC RENAL FAILURE
PRESENTED BY:
P.DIVYA POOJA
Y17PHD0822
II/VI PHARMD
NIRMALA COLLEGE OF PHARMACY

2. BRIEF SUMMARY OF CASE
• A 65 yrs old male patient was admitted in
hospital with chief complaints of cough with
expectoration & dysopnea since 1 week
• He had a past history of DM, Oliguria,
Dysuria, Hyperthyroidism
• His bowel and bladder habits are normal with
normal appetite
• This case was evaluated in SOAP format

3. SUBJECTIVE
• A 65 years old male patient admitted in
hospital with chief complaints of cough with
expectoration & dysopnea since 1 week.
• He has a past history of Oliguria, Dysuria, DM,
Hypothyroidism
• His bowel & bladder habits are normal with
normal appetite.

4. OBJECTIVE
• Physical examination-
Conscious
Temperature-98 c
BP-140/90 mm of hg
PR-100 beats/min
RR-20 cycles/min
SPO2-96%
• Systemic-
CVS-S1S2+
CNS-NFD
RS-BAE
Mild abdominal distention, Pallor

5. BIOCHEMICAL
INVESTIGATIONS
S.NO. PARAMETER OBSERVED NORMAL
1. RBC 2.24 million
cells/cu.mm
4.2-5.6 million
cells/cu.mm
2. WBC 3000cells/cu.mm 4000-
10000cells/cu.mm
3. MONOCYTES 1% 2-3%
4. GRBS 293 mg/dl 100-140mg/dl
5. HEAMOGLOBIN 6.2 g/dl 14-18 g/dl
6. HEMATOCRIT 19.1% 34-54%
7. RDW 17.3% 11.5-14.5%

6. ASSESSMENT
• Based on the subjective and objective data,
the final diagnosis is that the patient is
suffering with CRF(Chronic renal failure)
• Definition: It is an irreversible deterioration in
renal functioning / numerous renal diseases
resulting from progressive loss of glomerular,
tubular functioning of both the kidneys.
• Etiology & Risk factors: Age, Diabetes,
Hypertension

7. STAGES OF CKD

8. PATHOPHYSIOLOGY
Decreased nephron number
Adaptive hyperfilteration at glomerulus
Increased glomerular permeability Proteinuria
Increased filteration of proteins

9. Nephrotoxic inflammation
Tubulo interstitial fibrosis Systemic
complications
Decreased urine Decreased GFR

10. CLINICAL PRESENTATIONS
• Polyuria
• Oliguria
• Dehydration
• Anemia
• Hypertension
• Diabetes
• Dysopnea
• Weakness
• Hypothyroidism

11. STANDARD TREATMENT
• Taking medications called ACE inhibitors / ARB
reduces BP and levels of protein in urine will
be controlled
• Finally, thought to slow the progression of
CKD

12. PLAN
GOALS-
• To get symptomatic relief
• To avoid further complications
• To decrease the disease progression

13. DRUG CHART

14. DRUG CHART
S.NO
.
Brand
name
Generic
name
Dose ROA Frequen
cy
Use Indication
1 T.Dytor Torsemide 10 mg p/o BD Diuretic To treat HTN
2 T,Abilife Aripiprazo
le
200 mg p/o OD Anti
psychotic
To avoid
anxiety
3 T.Morteg
a
Cefixime+
salbactum
150 mg p/o BD Antibiotic To prevent
bacterial
infections
4 T.montai
r-LC
Monteleu
kast
15 mg p/o OD Anti
histamine
To avoid
allergy
5 Inj.mixta
rd insuin
Human
mixtard
24 units SC BD Anti diabetic To maintain
sugar levels

15. Brand name Mechanism of action Adverse effects Monitoring parameters
1.Tab.Dytor Sulfonylurea diuretic, acts on
ascending portion of LOH &
inhibits Na-K-Cl carrier system
ECG abnormality, chest
pain, nervousness,
diarrhea, polyuria,
constipation, cough
Serum electrolytes,
serum glucose, renal
functioning, BP, diuresis
2.Tab.Abilife Acts as antipsychotic by
inhibiting dopaminergic
neurotransmission in
mesolimbic pathway
Headache, drowsiness,
sedation, agitation, fatigue,
anxiety
BP, DM, weight,height.,
electrolyte balance,
libido, galactorrhea
3.Tab.Mortega Binds to penicillin binding
receptors and arrests bacterial
cell wall synthesis and stops
growth
Diarrhea, ARH, hepatitis,
headache, increased BUN,
jaundice
Renal functioning,
hepatic functioning
4.Tab.Montair-LC Blocks binding to leukotriene
D4 to its receptors and inhibits
inflammatory processes
Headache, dizziness,
fatigue, eczema, dermatitis,
nausea, influenza
Mood/behavioral
changes including suicidal
thinking or behavior
5.Inj.Human
insulin
Facilitates binding of insulin to
its receptors on muscle &
inhibits glucose output from
liver
Peripheral edema,
hypoglycemia, anaphylaxis,
hypersensitivity and
lipotrophy at injection site
Serum K & glucose levels,
BUN, HbA1C,
electrolytes, weight,
plasma glucose, renal and
hepatic functioning

16. PATIENT COUNSELLING
About disease:
• Numerous renal diseases resulting from
progressive loss of glomerular & tubular
functioning of both the kidneys

17. About drugs:
• Cefixime- with/without milk twice a day
• Aripiprazole- with/without food
• Salbactum- Avoid with milk
• Monteleukast-twice a day without food
• Insulin- 20 minutes before meal

18. SPECIAL INSTRUCTIONS
• Follow low salt diet & low fat diet
• Limit alcohol and quit smoking
• Exercise at least for 30 minutes per day
• Maintain blood sugar levels
• Take regular checkup & medications
• Keep healthy weight