case presentation on lcdd and ckd

CHRONIC KIDNEY

DISEASE, LCDD AND

HYPERTENSION

By

Amarnath Mullapudi

NIPER Mohali

1

CHIEF COMPLAINTS

• Generalized weakness x 6 months

• Shortness of breath x 6 months

• Fever x 3 weeks

• Edema of lower limbs x 3 months

2

PATIENT DETAILS

• Age : 48 years

• Sex : Male

• Weight : 58 kgs

• BP : 190/84 mmHg

• HR : 74 beats/minute

• RR : 20/minute

3

LAB INVESTIGATIONS

4

LAB INVESTIGATION-IParameter Normal

Range

Days

Na+ 136-145

mEq/L

D1 D2 D3 D4

134 136 136 142

D5 D6 D7 D8

139 136 134 138

K+

3.5-5

mEq/L

D1 D2 D3 D4

4.4 4.2 4.9 4.2

D5 D6 D7 D8

4.6 4.2 4.6 4.95

LAB INVESTIGATION-IIParameter Normal Range Days

Cl- 98-106

mEq/L

D1 D2 D3 D4

98 98.8 99.6 102

D5 D6 D7 D8

100 98 102.3 97.5

Urea 15-40

mg/dL

D1 D2 D3 D4

101.5 86.4 68.8 101

D5 D6 D7 D8

68.8 101 69 113.5 6

LAB INVESTIGATION-IIIParameter Normal

Range

Days

Creatinine 0.5-1.3

mg/dL

D5 D6 D7 D8

5.5 6.6 5.60 7.36

D5 D6 D7 D8

4.87 6.8 7.9 8.09

Bilirubin 0.3-1.3

mg/dL

D1 D2 D3 D4

0.8 0.4 0.5 0.6

D5 D6 D7 D8

0.7 01 0.2 0.2 7

LAB INVESTIGATION -IV

Parameter Normal Range

Days

Ca++ 8.6-10.2mg/dL

D1 D2 D3 D4

12.7 11.2 9.6 7.8

D5

6.6

D6

10.47

D7

11.4

D8

9.8

Phosphate 2.5-4.5mg/dL

D1 D2 D3 D4

6.0 6.0 5.2 5.7

D5 D6 D7 D8

5.7 4.3 8.0 7.8 8

LAB INVESTIGATION-VParameter Normal

Range

Days

Hb 13-18/dL D1 D2 D3 D4

8.5 9.1 9.3 10.2

D5 D6 D7 D8

11.1 9.8 8.7 10.5

TLC

4-11 x

103/micro

litre

D1 D2 D3 D4

7.2 9.5 8.9 7.8

D5 D6 D7 D8

7.9 8.2 8.0 7.8 9

DIAGNOSTIC TESTS

• Biopsy of Kidney

• Serum Protein Electrophoresis (SPEP)

• Urine Protein Electrophoresis (UPEP)

• Immunofixation (IFE)

10

DIAGNOSIS

• Chronic Kidney Disease (CKD)

• Light Chain Deposition Disease (LCDD)

• Hypertension

11

Medication Chart

12

Drugs Dose ROA Frequency Days

Metoprolol 50mg PO BD D1-D8

Prazosin 5mg PO HS D1-D8

Amlodipine 10mg PO TDS D1-D8

Torsemide 100mg PO TDS D1-D8

13

Drugs Dose ROA Frequenc

y

Days

Clonidine 0.1mg PO OD D1-D8

Sevelamer 800mg PO TDS D1-D8

Vancomycin 1000mg IV EVERY 72

HOURS

D3&D6

Erythropoietin 10,000

iu

SC WEEKLY D1&D8

Pantoprazole 40mg IV OD D1-D8

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Pharmaceutical Issues

15

Drug Interactions

Metoprolol x Clonidine

Concurrent use of Metoprolol and Clonidine

may result in increased risk of Sinus

Bradycardia.

16

Drug Interactions

Metoprolol x Prazosin

Concurrent use of Alpha-1 adrenergic blockers

may result in exaggerated Hypertensive

response.

17

MANAGEMENT

• Heart rate and B.P should be monitored when

clonidine and metoprolol are administered.

Metoprolol should be withdrawn before the

gradual withdrawal of clonidine to avoid

rebound hypertension.

18

Advice as Pharmacist…

• Counseling should be provided to the patient

about sudden discontinuation of clonidine.

• Skipped dose of clonidine should be ignored &

continue the regular dose. Next dose should be

within 4 hours.

.

19

SUMMARY

• A 48 year old male was admitted to the hospital with the following complaints:-

• Generalized weakness, SOB and fever. Complaint of edema in lower limbs

• He was diagnosed with Chronic kidney disease, LCDD and Hypertension.

• He was administered with Beta blockers, alpha blockers, diuretics ,erythropoietin and sevelamer .

20

Summary cont…

• Vancomycin was administered to manage

catheter induced infection.

• The patient had been undergoing

haemodialysis for the management of Chronic

Kidney Disease.

21

REFRENCES

• Harrison’s Principle of Internal Medicine, 18th

Ed.

• Bailey RR & Neale TJ: Rapid clonidine withdrawal with blood pressure overshoot exaggerated by beta-blockade. Br Med J 1976; 1:942-943.

• Micromedex

• Light chain deposition disease: novel biological insightsand treatment advances

V. H. JIMENEZ-ZEPEDA

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