renal caliculi , types , drug therapy , adverse reactins and mechanism of drugs , frequency and patient counseling

1. case presentation on
Right ureteric caliculi
T . Sai swapna
II/VI Pharm . D
Nirmala college of pharmacy
Department of pharmacy
practice

2. Case summary;
• A female patient of age 61 years suffering from right
lion pain since few years burning sensation , decreased
micturition , past history includes oliguria , diabetes ,
sciatica & lumbar spondylitis , sleep and appetite was
found to be normal
• Based on lab parameters and other tests the patient
diagnosed with right ureteric caliculus .
• The patient was normalised at the time of discharge and
prescribed with medications
• The case was evaluated in the SOAP format

3. Subjective data ;
• A female patient of age 61 years suffering from pain ,
burning sensation , past history includes oliguria ,
diabetis , sciatica , lumbar spondylitis .
• His sleep and appetite was found to be normal .
• Bowel was found to be regular .

4. Objective data ;
• Physical examination;
• Pulse- 84 b/m
• BP – 110/70 mm of hg
• Temperature – 98 degrees F
• RR – 26 b/m
• PICKLE – Normal
• Systemic examination;
• CVS – s1 s2 +
• CNS - NFND
• P/A –soft and non tender
• RS – BAE +

5. Lab tests ;
• RBC –4.48 million c/cubic mm (4.2-5.6)
• WBC – 10,000 c / cubic mm (4,000-10,000)
• Hb – 11.6g/dl (14-18)
• Heamotocrit – 35.2% ( 34 – 47 )
• MCV – 78.6FL (78-98)
• MCH – 25.8pg (27-35)
• MCHC – 32.8g/dl (31-37)
• Platlets – 2,36,000 c/cub.mm (1,40,000-4,50,000)
• RDW – 14% (11-14.5)
• Serum creatinine – 1.30 mg/dl (0.6 – 1.2 )

6. Lab tests;
• GLUCOSE – fasting - 114mg/dl
• random - 206 mg/dl
• Others ;
• CT scan of kidney and UB -
• Impression ; large proximal uteric calculus producing
moderate hydronephrosis .
• X – ray of K & UB –
• Impression ; right proximal ureteric calculi
• Chest X ray – No obvious abnormalities
• ECHO – Normal cardiac chambers

7. Others ;
Hepatitis b & c antigen ; negative

8. Assessment ;
• Based on the subjective and objective data the final
diagnosis as follows RIGHT URETERIC CALICULI
• DEFINITION ; Mineral mass in ureterus
• ETIOLOGY ; Several reasons not particular .
• RISK FACTORS;
• Low fluid intake
• Increase Calcium absorption into intestine
• Gout
• HTN
• Hyperparathyrodism
• Colitis

9. Types ;

10. Types;
• Calcium oxalate crystals ; common
• Styruvite crystala ; mostly in women
• Uric acid crystals; more in men
• Cystine crystals ; rare

11. Pathophysiology;

12. CLINICALMANIFESTATIONS;

13. Signs and symptoms ;
• Severe pain in the back and side of abdomen
• Pain during micturition
• Reddish urine
• Vomiting
• Fever and chills if any UT infection
• Urination frequently
• Heamaturia
• Cloudy urine

14. Plan ;
• Goals;
• To decrease signs and symptoms
• To decrease disease progression
• To decrease further complications involved
SURGERIES includes percutaneous nephrolithotomy , extra
corporeal shock wave lithotripsy (ESWL)
Recommended for PCNL right and ESWL right

15. Management ;

16. Drugchat ;
s.n
o
Brand name Generic name Dose ROA Frequency Duration of
therapy
1 . Inj .magnex
forte
Cefperazone
&salbactum
1
gm&
500m
g
IV BID 3 Days
2 . Inj. Tranexa Tranexamic
acid
100m
g/ml
IV BID 3 Days
3 . Inj . Aciphex Rabeprazole 20mg IV OD 3 Days
4 . Inj . Ultram Tramadol 50mg IV BID 3 Days

17. s.no Drug MOA Indication ADR’S MP
1 . Inj . Magnex
forte
- Cell wall
synthesis
To treat
infection
Rash , fever
urticaria ,
liver
enzymes
increase
Blood profile
,liver
enzymes ,
creatinine
2. Inj. Tranexa Inhibit
fibrinolysis and
decrease
inflammation
To treat
renal
impairmen
t
Nausea ,
vomiting's,
hypotensio
n,
diarrheoa
BP, blood
profile,
kidney
functioning
3. Inj. Aciphex - Gastric
secretion
prophylaxis Headache,
constipatio
n, pain,
anemia
Blood
profile,ECG,n
a&K levels
4 . Inj. Ultram Bind to opiod
receptors and -
pain
To
decrease
pain
Constipatio
n, nausea ,
dizziness,
anxiety
Patient
conditions
like anxiety

18. DRUGINTERACTIONS;
No drug drug interactions

19. Patientcounseling;
• About disease ;
• It is due to the mineral and salt deposition in ureter
• These block the urine passage through ureter
• Renal insuffiency occurs and creatinine levels are abnormal

20. Life stylemodifications;

21. Life style modifications ;

22. Diet therapy;
• To reduce oxalate crystals ;
• Aviod nuts , rhubarb, spinach , wheat
• To reduce sodium crystals ;
• Aviod salt and meat and packed fast foods
• Limit animal protein ; eggs and meat
• To reduce uric acid crystals;
• Aviod beef , chicken , eggs , fish
• To reduce cysteine stones ;
• Drink water

23. THANK YOU