this is case presentation

1. .
COLLEGE OF HEALTH SCIENCE
SCHOOL OF PHARMACY
ATTACHMENT SITE:IM
Case Presentation on AKI on CKD secondry to RPGN+Known
Bronchial Asthma+moderate anemia secondry to CKD+Acute
pyelonephritis(treated)+Acute gastroenteritis.
Prepared by:Mubarek Abdulmajid
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2. Outlines
Patient demographics
History of patient
Physical examination
Lab values
Current drug therapy
Pharmaceutical care
Patient counseling
Monitoring
References
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3. Demographic Data of S.H
 Name…………...S.H
 Age………..…..55yrs
 Sex…...……….. Male
 Weight .……….62 Kg
 IC.……………..204231
 Address……...….Adama
 Admission date:27/01/2023
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4. History
C.C:He complains of mild lower extremity swelling
and epigastric burning pain.
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5. Cont…
HPI: This is a 55 years old male patient presented
with 1 week history of reddish discoloration of
urine,periorbital swelling,decreased urine output and
dysuria.He also has left flank pain and LGIF.
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6. Cont…
 FH:No family memebers with chronic disease.
Allergies and ADRs: No Hx of allergy & ADRs
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7. Cont…
 Medication History:
 Methylprednisolone 1gm Iv daily for 3 days(28/01/2023)
 Lasix 200mg IV in 50ml NS over 30min stat(on 26/05/15)
 10 IU regular insulin with 3 vials of 40% dextrose(on 30/01/2023)
 Took 5 cycles of cyclophosphamide(5th cycle on 22/05/15)
 Omeprazole 40mg iv bid
 Ceftriaxone 1gm iv bid
 Hct 25mg po daily
 Metronidazole 500mg po tid for 5 days( on 07/02/2023)
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8. Physical Examination
GA :well looking
HEENT: Pink conjunctiva, Non icterus sclera(slight
periorbital puffing ).
LGS:No LAP.
CHEST: Clear and resonant.
CVS: S1 and S2 heard, No M or G
8

9. Cont…
Abd: Flat moves with respiration.no tenderness or
organomegally.
CNS: COTPP
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10. Vital signs
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11. Pertinent laboratory findings
CBC 27/01/2023 17/02/2023 24/01/2023 Reference range
WBC 8.8 2.85 6.96 3.98-
10.04x10^3/ul
RBC 2.71 2.49 2.47 3.93-
5.22x10^6/ul
HGB 8.5 9 9.7 11.2-15.7g/dl
HCT 24.4 22.3 23.5 34.1-44.9%
MCV 90.0 89.6 95.1 79.4-94.8 fL
MCH 31.4 31.7 31.6 23.8-33.4pg
MCHC 34.8 35.4 33.2 32.5-36.3g/dl
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12. Cont…
PLT 239 175 176 182-369
x10^3/ul
RDW 14.4 13.8 14.0
MONO 5.3 5.2 2.5.-4.7%
MONO# 0.15 0.36 0.24-
0.36x10^3/uL
EOS 0.0 0.0 0.7-5.8%
EOS# 0.00 0.00 0.04-
0.36x10^3/uL
NEUT 72.7 85.9 87.9 34.0-71.7%
NEUT# 6.4 2.45 6.12 1.56-
6.13x10^3/uL
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13. Cont…
BASO 0.0 0.1 0.1-1.2%
BASO# 0.00 0.01 0.01-
0.08x10^3/uL
LYMPH 17.6 8.6 6.8 19.3-51.7%
LYMPH# 1.5 0.25 0.47 1.18-
3.74x10^3/uL
P-LCR 17.5 34.4 31.8 %
PCT 0.21 0.20 0.20 %
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14. Electrolyte
27/01/2023 17/02/2023 20/02/2023 Reference
range
Na+ 132.8 132.1 144 136-145mmol/l
K+ 5.35 3.76 4.83 3.6-5mmol/l
Cl- 99.5 104.6 116.9 98.0-
107.0mmol/l
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15. LFT and RFT
27/01/2023 17/02/2023 24/02/2023 Normal range
AST 132 12.8 16.1 0.0-38.0Iu/l
ALT 0.0-41.0Iu/l
ALP 69 73 40.0-129.0Iu/l
Cr 7.59 5.23 4.95 0.67-1.17mg/dl
BUN 136.2 199.5 211.6 16.6-48.5mg/dl
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16. UAA
27/01/2023 17/02/2023 Reference range
APP Clear clear
Color Yellow yellow
pH 6.5 5 5.0-8.0
SG 1.010 1.020 1.0-1.02
Protien +3 +2
GLu negative negative
Ketone negative negative
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17. Cont…
BLD +4 +2
LEUC +3 +3
URO Negative Negative
BILI Negative Negative
RBC UA Full field Moderate 4.06-5.63/HPF
WBC UA Full field Full field 3.6-10.2/HPF
BAC Negative Full field
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18. Urine output
30/05/15 06/06/15 12/06/15
Input 250ml 660ml 320ml
Output 100ml 890ml 750ml
Balance +150ml -230ml -430ml
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19. Abdominal Ultrasound(07/02/23)
 Echogenic right kidney likely renal parencyhmal
disease.
 Circumferential large bowel thickening likely colitis.
 Moderate ascites.
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20. Urine culture(08/02/2023)
 Klebsiella pneumonia
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21. Current diagnosis
P1 :AKI on CKD secondry to RPGN
P2 :Known Bronchial Asthma
P3 :Moderate anemia secondry to CKD
P4:Acute pyelonephritis(treated)
P5 :Acute Gastroenteritis
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22. He Is Currently On
Medication Dose and
frequency
Indication Start date Stop date
Prednisolone 60mg po
daily
RPGN 6 month back -
CPT 960mg
3x/week
Prophylaxis 28/01/2023 -
Beclomethasone 2puffs bid B.Asthma -
salbutamol Puff PRN B.Asthma
ciprofloxacin 200mg iv
daily
gastroenteritis 23/02/2023 -
Omeprazole 20mg po bid Epigastric pain 20/02/2023 -
22

23. Patient progression
The patient have good progression i.e.
 His potassium level was corrected.
 The fever were relieved.
 Increased urine output.
 Acute pyelonephritis were treated.
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24. Pharmaceutical Care
Subjective findings
 Has no urinary frequency
 Has epigastric burning pain
Objective findings
P/E - BP- 130/80
PR-74/min(regular) k+=4.83mmol/l
RR-20
U/O:
Input:320ml
Output:750ml
Balace:-430ml
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25. Assessment
Drug related
need
Indication DTP Recommendati
ons
References
Adherence/co
mpliance
RPGN The patient is
unwilling to
take
Prednisolone as
prescribed.
I recommend to
take the steroid
as prescribed as
corticosteroids
have been
shown to
improve renal
function and
survival.
Evidence-based
clinical practice
guidelines for
rapidly
progressive
glomerulonephr
itis 2022.
Safety RPGN The medication
dose is too high
I recommend a
reduction of the
oral
prednisolone
dose to 30 mg
to prevent
opportunistic
infection.
Evidence-based
clinical practice
guidelines for
rapidly
progressive
glomerulonephr
itis 2022.
25

26. Cont…
Drug related
need
Indication DTP Recommendati
on
References
Indication DVT The patient
requires
additional drug
therapy
Since the
patient is at
high risk of
thrombosis-
associated
cardiovascular
events,the
patient needs
UFH 7500 IU
S/C bid for
DVT
prophylaxis.
Evidence-based
clinical practice
guidelines for
rapidly
progressive
glomeruloneph
ritis 2022.
26

27. Desired Outcomes
Eradications of infections.
Maintain normal serum electrolyte
Allivate symptoms
Maintain urine out put balance negative
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28. Pharmacotherapeutic plan
 Initiate UFH 7500 IU SC BID.
 Make patient Adherent to steroids.
 Reduce the dose of oral prednisolone to 30mg po
daily.
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29. Patient Counseling
 Salt restrictions
 fluid restrictions.
 Take the medication as prescribed( i.e Adherence to
medication).
 Instruction for use of Beclomethasone
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30. Monitoring Parameters
Vital signs
CBC
electrolyte
Urine tests
Urine output
Renal function test
Clinical sign and symptoms
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31. Communication and implementation of
the pharmacotherapeutic plan
The plans have communicated and some of them
have been implemented and some are on progress.
 Adherence to prednisolone(accepted and
implemented)
 UFH 7500 IU SC BID(on progress)
 Prednisolone 30mg po daily(on progress).
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32. References
1. STG 2020
2. Uptodate 2018
3. Joseph_T_DiPiro,_Gary_C_Yee,_L_Michael_Posey_edit
ors_Pharmacotherapy
4. Evidence-based clinical practice guidelines for rapidly
progressive glomerulonephritis 2022.
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33. .
THANK YOU
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