A 64-year-old male presented with severe breathlessness, decreased urine output, loss of appetite, bilateral leg swelling, and general weakness. He has a history of hypertension for 3 years. On examination, his blood pressure was elevated and GFR was below 15 mL/min/1.73 m2, indicating stage 5 chronic kidney disease. He was diagnosed with CKD and hypertension. Treatment included furosemide, calcium gluconate, pantoprazole, B complex, atorvastatin, amlodipine/atenolol combination, and paracetamol for symptoms.

1. A CASE PRESENTATION ON
CHRONIC KIDNEY DISEASE(CKD)-
STAGE V
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SUBMITED BY
METI.BHARATH KUMAR
16DK1T0014

2. PATIENT DEOGRAPHIC DETAILS
• PATIENT NAME : S.BHASKAR RAO
• ADMISSION (IP) NO : 149941
• DEPARTMENT : NEPHROLOGY
• WARD/UNIT : 5 TH SPECIAL WARD
• AGE : 64 YEARS
• GENDER : MALE
• HEIGHT : 165 CMS
• WEIGHT : 65 KGS
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3. CHIEF COMPLAINTS
• COMPLAINTS AND DURATION (CC) :
Severe breathlessness since 1 week,
Decreased urine output since 4 days,
Loss of appetite since 4 days,
Bilateral pedal oedema since 4 days,
General weakness
S/P : over usage of analgesics
• H/O :
Breathlessness
• Past Medical History (PMH):
Known case of hypertension(HTN) since 3 years
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4. PERSONAL/SOCIAL HISTORY AND
HABITS
• Diet (veg/non-veg): mixed diet
• Appetite: decreased (loss of apetite)
• Sleep: normal
• Bowel & Bladder habit: regular
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5. GENERAL EXAMINATION
PHYSICAL EXAMINATION:
VITAL SIGNS:
Temperature (oF)/C: Afebrile 98.6/37
Respiratory rate (Cycles/min.): 19/min
Pulse rate (beats/min.): 79/min
Blood Pressure (mm of Hg): 140/90
PROVISIONAL DIAGNOSIS:
CKD STAGE V,HTN
•
•
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6. SYSTEMIC EXAMINATION(ROS):
PATIENT IS C/C
CVS : S1S2+
RS : BAE+
CNS : NAD
GI (ABDOMEN) & GU: Soft, no tenderness,BS+
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7. LAB INVESTIGATIONS
URINE ANALYSIS:
BLOOD (Haematuria) ALBUMIN(Albuminuria): <30MG
PROTIEN(Proteinuria) KETONE(Ketonuria)
BLOOD ANALYSIS :
CREATININE HYPOCALCEMIA
UREA (AZOTEIA) LEADING TO UREMIA
SERUM CREATININE
HYPERPHOSATMEIA Hgb (ANAMEIA)
POTASSIUM (HYPERKALAMEIA )
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8. OTHER INVESTIGATIONS
• Kidney scans - kidney scans may include a magnetic resonance imaging
(MRI) scan, computed tomography (CT) scan, or an ultrasound scan. The
aim is to determine whether there are any blockages in the urine flow.
These scans can also reveal the size and shape of the kidneys - in
advanced stages of kidney disease the kidneys are smaller and have an
uneven shape.
• Kidney biopsy - a small sample of kidney tissue is extracted and examined
for cell damage. An analysis of kidney tissue makes it easier to make a
precise diagnosis of kidney disease.
• Chest X-ray - the aim here is to check for pulmonary edema (fluid retained
in the lungs).
• Glomerular filtration rate (GFR) - GFR is a test that measures the
glomerular filtration rate - it compares the levels of waste products in the
patient's blood and urine. GFR measures how many milliliters of waste the
kidneys can filter per minute. The kidneys of healthy individuals can
typically filter over 90 ml per minute
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9. DRUG CHART
SL.
NO.
BRAND
NAME
GENERIC
NAME
CATEGORY/CL
ASS
DOSE ROA FREQ.
1 LASIX Furosemide DIURETIC 20 MG IV BD
2 CALCIUM
GLUCONATE
calcium
gluconate
MINERALSUPPL 1 A IV BD
3 PANTOCID Pantoprazole ANTACID 40 MG IV OD
4 BEPLEX FORTE B Complex VIT SUPPL 1 TAB ORAL OD
5 LIPITO Atorvastatin STATINS 10 MG ORAL OD
6 AMLOKIND -
AT
Amlodipine
(5 mg) +
Atenolol (50
mg)
ANTI-HTN 5/50
MG
ORAL OD
7 DOLO 650 Paracetamol ANALGESIC 650 ORAL STAT
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10. SOAP NOTE:
Subjective evaluation: A 64 yrs male patient was admitted in General
medicine ward with chief complaints of Severe breathlessness
since1 week, Decreased urine output since 4 days,Loss of appetite
since 4 days, Bilateral pedal oedema since 4 days, General
weakness.He takes mixed diet.Loss of appetite ,normal sleep ,normal
bowel & abnormal bladder is noticed.
Objective evaluation: On general examination , the patient was
consciou& oriented , on physical examination all vital signs are
normal except the blood pressure(140/90)HTN along with GFR
level (mL/min/1.73 m2) < 15
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11. Assessment:
Based on the objective & subjective evaluation the patient
was diagnosed chronic kidney disease (CKD). so the patient
was treated with the following medications
• LASIX
• CALCIUM GLUCONATE
• PANTOCID
• BEPLEX FORTE
• LIPITO
• AMLOKIND -AT
• DOLO 650
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12. PLAN (OF TREATMENT):
• On day 1 :
Based on the history & present signs and symptoms the following
treatment is given inj LASIX –a diuretic ;CALCIUM GLUCONATE-a mineralsupple
ment ;PANTOCID-an antacid ;LIPITO – a statins ;AMLOKIND –AT an anti-
hypertensive drug
• On day 2:
On chief complaints of anemia and fever taken place. TAB BEPLEX FORTE
;TAB DOLO 650 is also given.
• On day 3:
Shows the same Complaints.Does not show any effects.
• On day 4:
Later the patient is good &discharged With same prescription
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13. PHARMACEUTICAL CARE ISSUES/CLINICAL
PHARMACIST INTERVENTION
(Rationality, ADR’s, DI, MER’s & any other drug related
problems)
• The prescription order was found to be
rational.There are no such drug related problem.
• PATIENT COUNSELLING:
• Regarding disease:
 Chronic kidney disease occurs when a disease or
condition impairs kidney function, causing kidney
damage to worsen over several months or years.
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14. Regarding Life-style modification:
• Patients will be advised to reduce their nutritional
phosphate intake - this usually means reducing
consumption of dairy products, red meat, eggs, and fish.
• NSAIDS should be avoided
• Most patients will be asked to restrict their fluid intake
• A low-salt diet
• High fatty food should be avoided.
• EPO supplements are advised
• Calcium and vitamin D supplements are advised
• Low protien diet
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15. Discussion: CHRONIC KIDNEY
DISEASE(CKD)-STAGE V
• INTRODUCTION:-
Definition :
Chronic kidney disease (CKD) is a type of kidney
disease in which there is gradual loss of kidney function over a
period of months or years.
• Chronic kidney disease, also called chronic kidney failure,
describes the gradual loss of kidney function.
• The kidneys filter wastes and excess fluids from your blood,
which are then excreted in your urine.
• When chronic kidney disease reaches an advanced stage,
dangerous levels of fluid, electrolytes and wastes can build up
in your body.
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16. AETIOLOGY:-
• Chronic kidney disease occurs when a disease or condition
impairs kidney function, causing kidney damage to worsen
over several months or years.
Diseases and conditions that cause chronic kidney disease
include:
• Type 1 or type 2 diabetes
• High blood pressure
• Glomerulonephritis - an inflammation of the kidney's filtering
units (glomeruli)
• Interstitial nephritis - an inflammation of the kidney's tubules
and surrounding structures
• Polycystic kidney disease
• Prolonged obstruction of the urinary tract, from conditions
such as enlarged prostate, kidney stones and some cancers.
• Vesicoureteral - reflux, a condition that causes urine to back
up into kidneys.
• Recurrent kidney infection, also called pyelonephritis .
•
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17. SIGNS AND SYMPTOMS:-
Signs and symptoms of kidney disease may include:
• Nausea
• Vomiting
• Loss of appetite
• Fatigue and weakness
• Sleep problems
• Changes in how much you urinate
• Decreased mental sharpness
• Muscle twitches and cramps
• Swelling of feet and ankles
• Persistent itching
• Chest pain, if fluid builds up around the lining of the heart
• Shortness of breath, if fluid builds up in the lungs
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18. STAGES OF CKD
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CKD STAGE GFR LEVEL (ML/MIN/1.73 M2)
normal (90-120)
STAGE 1 ≥ 90 greater than
STAGE 2 60 – 89
STAGE 3 30 – 59
STAGE 4 15 – 29
STAGE 5 < 15 less than

19. RISK FACTORS:-
Factors that may increase your risk of chronic kidney
disease include:
• Diabetes
• High blood pressure
• Heart and blood vessel (cardiovascular) disease
• Smoking
• Obesity
• Being African-American, Native American or Asian-
American
• Family history of kidney disease
• Abnormal kidney structure
• Older age
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21. SAASTRA COLLEGE OF PHARMACETUCAL
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PATHOPHYSIOLOGY

22. DIAGNOSIS:-
• BLOOD TEST
• URINE TEST
• KIDNEY SCANS
• KIDNEY BIOPSY
• CHEST X-RAY
• GLOMERULAR FILTRATION RATE (GFR)
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23. TREATMENT
• PHOSPHATE BALANCE
• SKIN ITCHING
• ANTI-SICKNESS MEDICATIONS
• AVOID NSAIDS (NONSTEROIDAL ANTI-
INFLAMMATORY DRUGS)
• FLUID RETENTION
• HIGH BLOOD PRESSURE MEDICATIONS.
• MEDICATIONS TO LOWER CHOLESTEROL LEVELS
• MEDICATIONS TO TREAT ANEMIA.
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