A 65-year-old male patient was admitted to the hospital with complaints of abdominal pain for 10 days. His medical history included diabetes for 20 years, hypertension for 25 years, and alcohol use for 40 years. Upon examination and investigation, he was diagnosed with chronic renal parenchymal disease, myocardial infarction, left lower lung consolidation, bilateral infiltrates, and renal cortical cysts. He was treated with medications and discharged with advice on diet, medication administration, and disease management. The pharmacist recommended monitoring his diabetic profile and adjusting medications as needed due to low blood sugar, and potentially switching beta blockers due to breathing difficulties.

1. PHARMACOTHERAPEUTICS
CASE PRESENTATION
RAJNANDINI SINGHA
III PHARM D

2. CASE STUDY
ON
CHRONIC RENAL
PARENCHYMAL DISEASE

3. SUBJECTIVE
A 65 year old Male patient was
admitted in PMCH on 13/7/2017
with the complaints of
abdominal pain for 10 days.

4. HISTORY OF PRESENT
ILLNESS
H/O Abdominal pain, pricking type,
more during at night.
H/O swelling, Difficulty in breathing
H/O Abnormal urine colour , Frequent
urination at night.
H/O LOA, LOW , Fatigue, fever
No H/O Abdominal distension.
H/O Muscle cramp.

5. PAST HISTORY
Diabetes mellitus for past 20 yrs.
Hypertension for past 25 yrs.
Taking medication such as STATINS

6. PERSONAL HISTORY
Diet: Mixed.
Alcohol for past 40 yrs.

7. GENERAL EXAMINATION
Patient conscious, oriented
BP :160/70 mmHg
PR :79 bpm

8. SYSTEMIC EXAMINATION
CVS – S1S2 Heard
RS - B/L AE+
CNS – NFND
P/A - Soft

9. OBJECTIVE
INVESTIGATION CHART
NAME OF
INVESTIGATION
OBSERVED VALUE NORMAL VALUE
WBC 6.2x109/L 4.5-10.5×109/L
RBC 4.26x1012/L 3.8-5.9×1012/L
HAEMOGLOBIN 9.5g/dl 12-14g/dl
PLATELETS 173.0109/L 130-400109/L
L/M/G 2.5/1.5/11.0109/L
MCV 92.9 FL 80-100FL
HCT 23.2% 35-50%
MCH 27.6pg 27- 34pg

10. MCHC 29.7g/dl 32-36g/dl
ESR 38mm/hr 0-20mm/hr
BIOCHEMISTRY
RBS 67 mg/dl Up to 140 mg/dl
BLOOD UREA 46 mg/dl 10-40 mg/dl
SERUM CREATININE 2.2mg/dl 0.6-1.3 mg/dl
GFR 14ml/min
SERUM PHOSPHATE 7.5 mg/dl 2.5-4.5 mg/dl
URINE ANALYSIS
COLOUR Brown
REACTION Acidic
ALBUMIN +

11. OTHER INVESTIGATION
ECG- sinus rhythm inferior
myocardial infraction.
X-RAY –Left lung lower lobe
consolidations , Bilateral
infiltrates .

12. USG ABDOMEN &
PELVIS:
B/L Chronic renal parenchymal
diseases.
B/L Small renal cortical cyst.

13. Myocardial infraction

14. Left lower lung consolidation

15. Bilateral infiltrates

16. Renal cortical cyst

17. ASSESMENT
FINAL DIAGNOSIS
Chronic Renal parenchymal
disease.

18. DRUG CHART
DRUG GENERIC
NAME
DOSE ROUT
E
FREQ 3 4 5 6 7
Inj.taxim cefotaxime 2gm IV bd √ √ √ √ √
T.RANTAC Ranitidine 150m
g
oral od √ √ √ √ √
T.BCT Vitamin B+
Vitamin C
Oral bd √ √ √ √ √
T. Dolo Paracetamol 650m
g
oral bd √ √ √ √ √
Inj. Deri Theophylline+
Etophylline
20mg IV bd √ √ √ √ √
T.LASIX FUROSEMIDE 40mg oral bd √ √ √ √ √
inj . Procrit Erythropoietin 100m
g
IV od √ √ √
T.Cozar Losartan 50mg oral od √ √ √ √ √

19. DRUG GENERIC
NAME
DOSE ROUT
E
FREQ 3 4 5 6 7
T.calcium
carbonate
Calcium
carbonate
2gm oral Od √ √ √ √ √
T.Hamengeol Propranolol 40mg oral Od √ √ √ √ √
T.Januvia sitagliptin 100mg oral Od √ √ √ √ √
T. Flovas Pitavastatin 2mg oral Od √ √ √ √ √

20. DISCHARGE SUMMARY
The patient was discharged on 8/07/17
DISCHARGE ADVICE
T . Lasix OD
T . Rantac OD
T.DERI 150 mg 1-0-1 (10)
T.Losartan OD
T.Calcium carbonate OD
T.BCT BD
T . Sitagliptin od
T. Pitavastatin od
Review after 1 week

21. PLAN
DISEASE BASED COUNSELLING
Blood purification must be done once to remove the metabolic
waste and toxins. Such as:
Dialysis
Blood perfusion
plasma exchange
Hypertension:
BP should be controlled.
Low intakes of salt
DIABETES MELLITUS:
Control sugar levels.
Obesity can progress to CKD

22. Renal cortical cyst:
Avoiding spicy foods, salted, leftovers,
polluted foods, greasy foods, stimulating foods
as chocolates, coffee, crabs, etc.
Avoid smoking , drinking alcohol. Nicotine and
alcohol can accelerate the growth of cysts,
elevate your blood pressure and worsen damages
on the kidneys.

23. Diet based counseling
Low protein diet, Low Salt Diet ,Limited intake of
potassium (milk or milk products, honeydew,
legumes, nuts, potatoes, seeds, tomato products
and yogurt.)
Limited intake of phosphorous(meats, whole grain
breads, cola beverages, cheese, dried beans ,
peanut butter, dairy products and chocolate).
Avoiding unhealthy fats.

24. DRUG BASED COUNSELLING
Ranitidine should be administered 30
minutes before consuming food
Furosemide should be administered 1 hr before
consuming food or 2 hrs after food.
Calcium carbonate should be taken 5 mins
before the food as it causes faster absorbtion of
calicium carbonate.

25. PHARMACIST INTERVENTION
The patient has very low RBS So the diabetic
profile should be monitored again and the drug dose should
be adjusted.
Beta blockers are sometime contraindicated in patient having
difficulties in breathing, so it can be switch to other classes
of drugs such as ACE INHIBITORS and ARB drugs.

26. THANK YOU