Chronic Kidney Disease (CKD) is a progressive condition characterized by the gradual loss of kidney function over time. Here's a comprehensive explanation of CKD in four steps: Causes and Risk Factors: CKD can result from various underlying conditions or risk factors that damage the kidneys' filtering units (nephrons) and impair their function. Common causes and risk factors include: Diabetes: High blood sugar levels over time can damage the blood vessels in the kidneys. Hypertension (high blood pressure): Elevated blood pressure can strain the kidneys' blood vessels and impair kidney function. Glomerulonephritis: Inflammation of the kidney's filtering units can lead to scarring and loss of function. Polycystic kidney disease: Inherited disorder characterized by the growth of cysts in the kidneys, leading to kidney enlargement and loss of function. Prolonged obstruction of the urinary tract: Conditions such as kidney stones or an enlarged prostate can obstruct urine flow, leading to kidney damage. Autoimmune diseases: Conditions like lupus or vasculitis can cause inflammation and damage to the kidneys. Certain medications: Long-term use of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or some antibiotics, can contribute to kidney damage. Stages and Progression: CKD is typically classified into five stages based on the estimated glomerular filtration rate (eGFR), which measures how well the kidneys are filtering waste from the blood. The stages are as follows: Stage 1: Kidney damage with normal or high eGFR (≥90 mL/min/1.73 m²) Stage 2: Mild decrease in eGFR (60-89 mL/min/1.73 m²) Stage 3: Moderate decrease in eGFR (30-59 mL/min/1.73 m²) Stage 4: Severe decrease in eGFR (15-29 mL/min/1.73 m²) Stage 5: Kidney failure (eGFR <15 mL/min/1.73 m² or dialysis) CKD progresses slowly over time, and symptoms may not be apparent until the later stages when significant kidney damage has occurred. Symptoms and Complications: In the early stages, CKD may be asymptomatic, and symptoms may only become evident as kidney function declines. Common symptoms and complications of CKD include: Fatigue and weakness Swelling of the legs, ankles, or feet (edema) Shortness of breath Nausea and vomiting Itching Loss of appetite Muscle cramps Difficulty concentrating Electrolyte imbalances (e.g., high potassium levels) Bone disease (e.g., osteoporosis) Anemia Complications of advanced CKD include cardiovascular disease, fluid overload, electrolyte imbalances, and kidney failure requiring dialysis or kidney transplantation. Management and Treatment: The management of CKD aims to slow the progression of the disease, manage symptoms, and prevent complications. Treatment may involve: Lifestyle modifications: Maintaining a healthy diet low in salt, potassium, and phosphorus, exercising regularly, maintaining a healthy weight, and quitting smoking. Blood pressure control: Medications such as ACE inhibitors

1. BY,
SRIRAM THIRUNAVUKKARASU,
PHARM.D IIIRD YEAR,
380020514525,
PGP COLLEGE OF PHARMACEUTICAL SCIENCE AND
RESEARCH INSTITUTE,
NAMAKKAL.
CASE STUDY ON
CHRONIC KIDNEY DISEASE

2. CASE SUMMARY
• A 73 years old female patient was admitted in hospital on 11/07/2023 with chief complaint of
sudden onset of fever with chills and rigors associated with decreased urine output. Now she is
admitted for further evaluation and treatment.
• The patient has past medical history of Diabetes mellitus, Systemic hypertension and Chronic
kidney injury.
• The patient has past medication history of Inj.Human mixtard, T. Taurine + Acetyl cysteine, T.
Rosuvastatin, T. Torsemide and T. Alprazolam.
• The patient was diagnosed to be Cystitis, Diabetic nephropathy and Acute kidney disease on
Chronic kidney disease.
• She has no social history .
• She has no known food or drug allergies.
• Inj. Meropenem, Inj. Paracetamol, Inj. Pantoprazole, Inj. Ondansetron, Inj. Human mixtard, T.
Taurine + Acetyl cysteine, T. Rosuvastatin, T. Torsemide, T. Levofloxacin and T. Alprazolam were
the drugs given to the patient during hospitalization.
• She was discharged on 14.7.2023.

3. CHRONIC KIDNEY DISEASE
DEFINITION
• CKD is a condition in which the kidneys are damaged and cannot filter blood as well as
they should.
• Because of this, excess fluid and waste from blood remain in the body and may cause
other health problems, such as heart disease and stroke.

4. PATHOPHYSIOLOGY

5. SOAP ANALYSIS

6. SUBJECTIVE
• A 73 years old female patient was admitted in hospital on 11/07/2023 with chief
complaint of sudden onset of fever with chills and rigors associated with decreased
urine output. Now she is admitted for further evaluation and treatment.
• The patient has past medical history of Diabetes mellitus, Systemic hypertension
and Chronic kidney disease.
• The patient has past medication history of Inj.Human mixtard, T. Taurine + Acetyl
cysteine, T. Rosuvastatin, T. Torasemide and T. Alprazolam.
• The patient was diagnosed to be Cystitis, Diabetic nephropathy and Acute kidney
disease on Chronic kidney disease.
• She has no social history .
• She has no known food or drug allergies.

7. • The patient was conscious, oriented and febrile.
• No head injury
• Eye movement normal
• CVS - S1S2 Normal
• RS - B/L AE(+)
• CNS – NFND.
• GIT-P/A - Soft.
• The patient have peripheral edema and distended abdomen.
OBJECTIVE
On Physical Examination,

8. S.
NO
PARAMETERS DAY 1 DAY 2 DAY 3 DAY 4
NORMAL
RANGE
1. TEMPERATURE 100 99 98 97.5 97.2-98.8 ֯ F
2. BLOOD PRESSURE 100/70 110/50 130/75 120/90
120/80
mmHg
3. PULSE RATE 64 82 80 90
60-100
Beats/min
4.
RESPIRATORY
RATE
18 16 20 18
12-16
breaths/ min
5. SPO2 94 98 96 96 95-100%
VITAL SIGNS:

9. LABORATORY TEST:
LAB INVESTIGATION 11/7/23 NORMAL VALUES
FULL BLOOD COUNT
Hb 10.4 12-15 g/dL
RBC 4.01 4-5.65 million cells/cu.mm
WBC 11930 4000-11300 cells/cu.mm
PCV 31.06 40-52%
Platelet 149000 150000 - 450000 cells/µl
LIPID PROFILE
T. Cholesterol 175.9 0-200 mg/dL
TG 92.8 40-200 mg/dL
HDL 47 >50 mg/dL
LDL 110.34 <100 mg/dL
VLDL 18.56 3-20 mg/dL

10. PARAMETERS 11/7 12/7 13/7 14/7
NORMAL
RANGE
UREA 68.9 57 41.1 40 10-50mg/dL
SERUM
CREATININE
2.39 1.75 1.54 1.03 0.7-1.2mg/dL
SODIUM 132.6 131.0 132.0 133.6 133-145mEq/L
POTASSIUM 4.9 5.1 4.1 3.4 3.3-5.1mEq/L
RENAL PROFILE
PARAMETER 11/7 12/7 13/7 14/7
NORMAL
RANGE
FBS 82 81 86 103 60-100mg/dL
OTHERS

11. URINE ANALYSIS VALUES NORMAL RANGE
Pus cells 80-100 0-5 cells/hpf
RBC 30-40 0 - 3 cells/hpf
Epithelial cells 2-3 15 - 20 cells/hpf
Specific Test
USG Abdomen and Pelvis Impressions
• Cystitis
• Mild spleenomegaly

12. PLAN
Goals Of Therapy,
 To treat the acute kidney injury via supportive care and antibiotic therapy for
infection.
 To screen for increase Hemoglobin content naturally or to preceed with blood
transfusion.
 To retain the normal urine output.
 To treat fever.
 To treat edema.

13. THERAPHY :-
DRUG DOSE ROA FREQUENCY 11/7 12/7 13/7 14/7
Inj. Meropenem 1 g IV TDS    
Inj.Paracetamol 1 g IV OD    
Inj. Pantoprazole 40 mg IV OD    
Inj. Human mixtard 10U-0-6U SC BD    
Inj. Ondansetron 8 mg IV TDS    
T. Acetylcysteine +
Taurine
500 + 150
mg
Oral OD   
T. Rosuvastatin 10 mg Oral OD    
T. Torsemide 10 mg Oral OD    
T. Levofloxacin 500 mg oral OD   
T. Alprazolam 0.5 mg Oral OD    

14. DRUG-DRUG INTERACTION
DRUG – 1 DRUG – 2 INTERACTION
Levofloxacin Alprazolam
levofloxacin increases levels of alprazolam by
decreasing metabolism.
Levofloxacin Ondansetron
levofloxacin and ondansetron both increase QTc
interval. Avoid or Use Alternate Drug
levofloxacin Human mixtard
levofloxacin increases effects of insulin regular
human by pharmacodynamic synergism. Use
Caution/Monitor. Quinolone antibiotic
administration may result in hyper- or
hypoglycemia.

15. DISCHARGE MEDICATION
S.NO DRUG DOSE FREQUENCY
1. Human Mixtard 30/70 BD(10U-0-6U)
2. T. Faropenem 200 mg BD(1-0-1)
3. T. Acetylcysteine+ Taurine 650mg OD(1-0-0)
4. T. Rosuvastatin 10 mg OD(0-0-1)
5. T. Torsemide 10 mg OD(1-0-0)
6. Cap.Esomeprazole 40 mg BD(1-0-1)
7. T. Alprazolam 0.5 mg OD(0-0-1)

16. DRUG BASED COUNSELLING
Take the medication properly in a correct dose and time properly.
Do inform the physician if you have any adverse effect.
T. Esomeprazole should be taken before meal time.
T. Alprazolam should be taken at the night time.
DISEASE BASED COUNSELLING
 CKD is a condition in which the kidneys are damaged and cannot filter blood as well
as they should.
 AKD is a condition of sudden deline function of kidney on your chronic kidey disease.
 The fluid accumulation in stomach area and legs are the symptoms of this disease.
PATIENT COUNSELLING

17. DIET BASED COUNSELLING
Avoid junk foods and high fatty.
Follow a no carbohydrate diabetic diet.
Decrease your salt intake.
Follow a low hydrated diet with good protein and fibre intake.
Avoid Ice creams and other outside foods.
Its better to have steamed vegetable without cooking it or spicing up with spices and oil.
LIFESTYLE BASED COUNSELLING
 Have enough rest.
 Sleep well at night and avoid overthinking.
 Be in a stress free environment.
 Don't put your legs fall on gravity for longer time.
 Sleep on one side rather than sleeping straight.

18. PHARMACIST INTERVENTION
 From the medication chart analysis, it was found that a serious interaction persist that
needs to be taken measure that levofloxacin and ondansetron both increase QTc interval
as she is proned to have some cardiac issues on her past medical history.
 The edematous symptoms persists yet. So she can be given with either Spironolactone
and Furosemide or Spironolactone and Toresemide which is the most widely used
combination for edema.

19. THANK YOU