The document presents a case study of a 60-year-old male patient diagnosed with chronic kidney disease (CKD), driven by diabetes and hypertension. It includes a SOAP analysis that details the patient's symptoms, objective findings, biochemical tests, and management plan, which encompasses medications and lifestyle modifications. The assessment indicates that the patient's renal function is severely compromised, necessitating interventions like dialysis or a kidney transplant.

1. 11
CASE Presentation ON CKD
PRESENTED BY:
M.SAI SRUTHI
II/VI PHARM-D
Y17PHD0819
DEPARTMENT OF PARMACY PRACTICE
NIRMALA COLLEGE OF PHARMACY

2. 2
•A 60 years old male patient suffering with chief complains of SOB
since one month and history of productive cough was initially
treated in a local hospital and was brought to Manipal for further
management.
•The patient is having past history of DM, medication not known.
•The above case was presented in the format of SOAP ANALYSIS.
CASE SUMMARY

3. 3
SUBJECTIVE EVIDENCE:
A 60 years old male patient suffering with chief complains of
SOB since one month , history of productive Cough and pedal
edema.
PAST HISTORY:
DM.
HTN recently diagnosed.
SOAP ANALYSIS

4. 44
PERSONAL HISTORY:
• Normal appetite.
• Regular bowel and bladder habits.
• Altered sleep.
• Non alcohol.
• Non smoker.

5. 55
• OBJECTIVE EVIDENCE:
PHYSICAL EXAMINATION:
• PR:72b/minute
• RR: 20 cycles/minute
• Bp:130/80mmHg
• SpO2: 98%
SYSTEMIC EXAMINATION:
• CVS:S1S2+
• P/A Soft
• RS:AE+
• CNS:NAD

6. 6
SNO PARAMETERS OBS
ERVED VALUES
NORMAL VALUES
1. S .creatinine 4.1mg/dl 0 to 1.2
2. BUN 47.21mg/dl 6 to 23mg/dl
3. S.Uric acid 8.8mg/dl 3.5to7.7mg/dl
Urine Analysis:
• Protein/ Albumin present 2+
• Glucose present
• Epithelial cells 4 to 6/hpf
BIOCHEMICAL TESTS:

7. 7
SNO PARAMETERS OBSERVED
VALUES
NORMAL
VALUES
1. Hemoglobin 10.1g/dl 11 to16g/dl
2. RBC 3.62mcells/cu mm 4.2 to 5.6 mcells/cu
mm
3. Lymphocytes 16% 14 to 44%
4. Hematocrit 30.7% 39 to 54%
5. RDW 14.1%
COMPLETE BLOOD COUNT:

8. 88
DIABETIC CHART:
DATE TIME GRBS DRUGS GIVEN
20/02/19 6 PM 300mg/dl 10 Units HA s/c
21/02/19 6 AM 147mg/dl 08 Units HA s/c
22/02/19 6 AM 177mg/dl 14 Units HA s/c
Ultra Sound (ABD) :
 Impression : Mild right pleural effusion
 Bilateral grade I/II renal parenchymal change and bilateral
 few tiny simple cortical cysts

9. 99
ASSESSMENT
• Based on the subjective and objective evidence the patient is
suffering with CKD.
• DEFINITION:
• Chronic kidney disease, also called chronic kidney failure,
describes the gradual loss of kidney function.
• Caused due to diabetes and hypertension.

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• CAUSES:
• 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 your kidneys
• Recurrent kidney infection, also called pyelonephritis.

12. 1212
• RISK FACTORS:

13. 13
PATHOPHYSIOLOGY:

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• Nausea and Vomiting
• Loss of appetite
• Fatigue and weakness
• Sleep problems
• 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
• High blood pressure (hypertension) that's difficult to control
SYMPTOMS:

15. 1515
STANDARD TREATMENT
• High blood pressure medications. angiotensin-converting enzyme (ACE) inhibitors or
angiotensin II receptor blockers
• Medications to lower cholesterol levels. atorvastatin
• Medications to treat anemia. Darbepoetin alfa
• Medications to relieve swelling. diuretics
• Medications to protect your bones. calcium and vitamin D supplements to prevent weak
bones and lower your risk of fracture.
• A lower protein diet to minimize waste products in your blood.
• Treatment for end-stage kidney disease
• Dialysis.
• Kidney transplant.

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DRUG CHART:
S
n
o
Drug
name
Dose ROA Freq Duration Indication Category MOA Side effects Monitoring
parameters
1. T
Diltiaze
m
30 mg p/o OD D2 To treat
increased bp.
CCB Inhibit Ca+2 ion
from entering
slow channels.
Body
pain,cough,chest
discomfort,D.
LFT,RFT,EEG,
HR,Bp.
2. Inj Feri
inject
500
mg
IV OD D2 To increase
iron content.
Iron salt. Releases iron Inc bp,N
,V,C,head ache.
Hb,hematocrit,vi
tals.
3. Inj
Monocef
(ceftriaz
one)
2 g IV BD D1 D3 To treat
infection.
Cephalospo
rin.(3rd
generation}
Inhibits bacterial
cell wall
synthesis.
Head ache,rash RFT.
4. T
Azee(azi
thromyci
n)
500
mg
p/o OD D1 D2 To treat
infection.
Macrolide. Inhibits RNA
dependent protein
synthesis.
D,N,head
ache,chest
pain,dizziness,fat
igue.
LFT,CBC.

17. 17
S
no
Drug name Dose ROA Freq Duration Indication Category MOA Side effects Monitoring
parameters
5. Inj
Pantodac
40 mg IV BD D1 D3 To relieve
GI
complication
PPI Supress the
gastric acid
secretion.
Head
ache,cough,V,ru
nny nose.
Bone loss and
fracture.
6. Neb duolin
Albuterol
ipratropium
1.25mg
500
mcg
p/n TID D1 D3 To relieve
SOB.
Anticholin
ergic
agent(bri-
onchodilat
or)
Relax sm and
open bronchial
passage.
Dizziness,bladde
r pain,inc HB.
FEV1
,PFT,Bp,HR.
7. Neb
budecort(bu
desonide)
0.5 mg p/n BD D1 D3 To relieve
SOB.
Corticoster
oid.
Controls
protein
synthesis
,depressses
migration of
polymorphonuc
lear leucocytes.
Bronchospasm,e
pistasis,pharyngi
tis.
Candida
infection.
8. T febuget 40 mg p/o BD D1 D2 To reduce
uric acid.
Xanthine
oxidase
inhibitor.
Selective
inhibitor
responsible for
conversion of
hypoxanthine
to xanthine.
Skin rash,N LFT,skin
reactions.

18. 18
S
no
Drug name Dose ROA Freq Duration Indication Category MOA Side effects Monitoring
parameters
8. T
Rosloygold(
rosuvastatin,
aspirin,clopi
dogrel)
20
mg
75
mg
75
mg
p/o OD D2 D3 To treat bad
cholesterol.
HMG CO A
inhibitor.
Inhibit HMG
CO A
reductase.
Head ache, C ,
N.
Lipid
panel,CPK.
9. MDI
Seroflo(fluti
casone
propionate,s
almeterol)
250
mcg
250
mcg
2
piffs
OD D2 To relieve
SOB
Corticostero
id.
Utilize
flurocarbothioat
e ester linkage
at carbon
position.
Muscle
cramps,head
ache,skin rash.
Skin
reactions.
10. T
Sodocel(sodi
um
bicarbonate)
500
mg
p/o TID D2 D3 To neutralise
st acid during
indigestion.
Antacid - Head ache,N
,V,dry
mouth,stomach
cramps.
Dehydration.
11. T Cudce 1 tab p/o OD D2 Probiotic. - - Taste
disturbances,N,f
ever.
-

19. 1919
PATIENT COUNSELLING
ABOUT DISEASE:
Chronic kidney disease, also
called chronic kidney failure,
describes the gradual loss of
kidney function.

20. 2020
DRUG INTERACTIONS:
MODERATE:
DILTIAZEM/ASPIRIN : bleeding , head ache , weakness.
ALBUTEROL/ SALMETEROL :Increase CV side effects (HR,Bp)
ASPIRIN/ CLOPIDOGREL :Bleeding abdominal pain , weakness.
AZITHROMYCIN/ SALMETEROL :increase risk of an increased heart rhythm.
DILTIAZEM/ BUDESONIDE :Diltiazem increase budesonide absorption.
CLOPIDOGREL/PANTOPRAZOLE :effect of clopidogrel is reduced.

21. 2121
LIFESTYLE MODIFICATIONS
• Control Bp.
• Reduce sodium intake.
• Manage diabetes.
• Take balanced diet.
• Take plenty of fruits and veggies.
• Low levels of fats.
• Exercise regularly.
• Stop smoking.
• Limit alcohol consumption.

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