CHRONIC KIDNEY

DISEASE, LCDD AND

HYPERTENSION

By

Amarnath Mullapudi

NIPER Mohali

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CHIEF COMPLAINTS

• Generalized weakness x 6 months

• Shortness of breath x 6 months

• Fever x 3 weeks

• Edema of lower limbs x 3 months

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PATIENT DETAILS

• Age : 48 years

• Sex : Male

• Weight : 58 kgs

• BP : 190/84 mmHg

• HR : 74 beats/minute

• RR : 20/minute

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LAB INVESTIGATIONS

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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)

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DIAGNOSIS

• Chronic Kidney Disease (CKD)

• Light Chain Deposition Disease (LCDD)

• Hypertension

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Medication Chart

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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

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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

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Drug Interactions

Metoprolol x Clonidine

Concurrent use of Metoprolol and Clonidine

may result in increased risk of Sinus

Bradycardia.

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Drug Interactions

Metoprolol x Prazosin

Concurrent use of Alpha-1 adrenergic blockers

may result in exaggerated Hypertensive

response.

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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.

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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.

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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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