CASE STUDY

on
Chronic Kidney Disease Stage 5 in Uremia
Secondary to Obstructive Uropathy; Anemia;
Complicated UTI; HVD
I. INTRODUCTION
Chronic Kidney Disease (CKD), also known as chronic renal disease, is a progressive loss of renal
function over a period of months or years. The symptoms of worsening kidney function are unspecific and
might include feeling generally unwell and experiencing a reduced appetite. Often, chronic kidney disease
is diagnosed as a result of screening of people known to be at risk of kidney problems such as those with
high blood pressure or diabetes.

Chronic kidney disease (CKD) occurs when the kidneys have been damaged over time and can no
longer function the way they should. Diabetes and high blood pressure are key risk factors. CKD can get
worse over time, and the kidneys may stop working altogether, known as kidney failure. In addition, CKD
can be a risk factor for other diseases, including cardiovascular diseases. If left untreated, CKD can
progress to more severe complications such as end-stage renal disease (ESRD) which requires more
immediate and regular interventions such as renal replacement therapies ranging from hemodialysis to
renal transplant. The increasing number of CKD cases have become an urgent national concern due to the
burden of the disease and high costs of care, according to the Department of Health (DOH).
 Chronic kidney disease (CKD) is among the leading causes of sickness and death in the
Philippines. Latest estimates (March 10,2023) show that around 2.3 million Filipinos have
CKD. The National Kidney and Transplant Institute (NKTI) estimates that one Filipino
develops chronic kidney failure every hour or about 120 Filipinos per million population
every year.

Globally, there are 10% of the population worldwide which is affected by chronic kidney
disease (CKD), and millions die each year because they do not have access to affordable
treatment. According to the 2010 Global Burden of Disease study, chronic kidney disease was
ranked 27th in the list of causes of total number of deaths worldwide in 1990, but rose to
18th in 2010.

With the numbers mentioned above, this case presentation aims, in general, to increase
awareness regarding these diseases and how to manage them.
 II. DEMOGRAPHIC DATA
A. IDENTIFICATION DATA
Demographic Profile
• Name: R.S.C Date of Admission: November 09,2023
• Age: 53 y.o Time: 12:43 AM
• Date of Birth: April 09,1970 Attending Physician: Dr. N.Y
• Sex: Male Address: La Libertad, Negros Oriental
• Civil Status: Married Occupation: Construction Worker
• Nationality: Filipino Height: 153 cm
• Religion: Roman Catholic Weight: 65kg.
• Chief Complaint: Hematuria
» Persistent Dyspnea
» Epigastric Discomfort
History of Present Illness:
2 weeks PTA, noted recurrent epigastric discomfort associated with nausea. Patient sought
consult to multiple institutions and was started on unrecalled medications with no relief. 3
days PTA, noted hematuria and urinary frequency. On the day of admission, noted onset of
dyspnea and flank pain thus admitted.
Past Medical History:
Known hypertensive, maintained Losartan 50mg tab OD PO. Had history of kidney
stones. Kidney stone surgery (2021)
Admission Diagnosis: Patient was admitted and managed as a case of Peptic Ulcer Disease
and Acute Complicated UTI
Principal Diagnosis: CKD5 in uremia secondary to obstructive uropathy; Anemia;
Complicated UTI; HVD
IV. DRUG STUDY
Generic Name: Pantoprazole
Classification: Protone Pump Inhibitor
Indications: Gastric acid pump inhibitor; belongs to a class of antisecretory compounds. Gastric acid
secretion is decreased by inhibiting the H+, K+-ATPase enzyme system responsible for acid
production.
Dosage: 40mg IV OD
Adverse Effects: Diarrhea, flatulence, abdominal pain. CNS: Headache, insomnia. Skin: Rash.
Nursing Responsibilities: Monitor for and immediately report S&S of angioedema or a severe skin
reaction.
Lab tests: Urea breath test 4–6 wk after completion of therapy.
Contact physician promptly if any of the following occur: Peeling, blistering, or loosening of skin;
skin rash, hives, or itching; swelling of the face, tongue, or lips; difficulty breathing or swallowing.
IV. DRUG STUDY
Generic Name: Piptaz
Classification: Anti-infectives
Indications: Used to treat serious bacterial infections such as: • chest infections • urine infections • stomach infections
• skin infections • gynaecological infections septicaemia (blood poisoning.
Contraindications: Contraindicated in patients with a history of allergic reactions to any of the penicillins and/or
cephalosporins or β-lactamase inhibitors
Cautious Use: SEIZURES (HIGHER DOSES), confusion, dizziness, headache, insomnia, lethargy.
Dosage: 2.25 grams IV q8h
Adverse Effect: SEIZURES (HIGHER DOSES), confusion, dizziness, headache, insomnia, lethargy.
Nursing Responsibility:
• Watch for seizures; notify physician immediately if patient develops or increases seizure activity.
• Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stools,
and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or nursing staff
immediately of these signs.

IV. DRUG STUDY
Generic Name: Piptaz
• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in
the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria). Notify
physician or nursing staff immediately if these reactions occur.
• Assess muscle aches and joint pain (arthralgia) that may be caused by serum sickness. Notify
physician if these symptoms seem to be drug-related rather than caused by musculoskeletal injury,
or if muscle and joint pain are accompanied by allergyc-like reactions (fever, rashes, etc.)
• Monitor signs of blood dyscrasias such as leukopenia and neutropenia (fever, sore throat, signs of
infection) or thrombocytopenia (bruising, nose bleeds, and bleeding gums). Report these signs to
the physician.
IV. DRUG STUDY
Generic Name: Tranexamic Acid
Classification: Antifibrinolytic
Indications: Indicated for the treatment of hereditary angioedema, cyclic heavy, and other instances of
significant bleeding in the context of hyperfibrinolysis.
Dosage: 500 mg IV q8h
Adverse Effects: Reported symptoms of tranexamic acid overdose include severe gastrointestinal
symptoms, hypotension, thromboembolism, visual impairment, convulsions, mental status changes,
and rash
Nursing Responsibilities: Monitoring for signs of allergic reactions, assessing renal function,
providing patient education about completing the full course of medication, and reporting adverse
reactions.
IV. DRUG STUDY
Generic Name: Diphenhydramine
Classification:H1 receptor antihistamine
Indications: Used in the treatment of seasonal allergies, and various allergic reactions including
sneezing, runny nose, itchy/watery eyes, itching of nose or throat, pruritus, urticaria, insect
bites/stings, and allergic rashes.
Cautious Use:When taking diphenhydramine, use caution driving, operating machinery, or performing
other hazardous activities. Diphenhydramine may cause dizziness or drowsiness.
Dosage: 25mg IV Pre-BT
Adverse Effects:Common side effects include feeling sleepy, dizzy or unsteady on your feet. You may
also have difficulty concentrating and have a dry mouth.
Nursing Responsibilities:
• Assess blood pressure periodically and compare to normal value
• Monitor respiratory function
IV. DRUG STUDY
Generic Name: Hydrocortisone
Classification: Corticosteroid
Indications: Replacement therapy in adrenal cortical insufficiency Allergic states severe or
incapacitating allergic conditions
Contraindications: Viral/fungal infections, tubercular or syphilitic lesions, bacterial infections unless
used in conjunction with appropriate chemotherapy.
Dosage: 100 mg IV Pre BT
Adverse Effects: Sodium and fluid retention. Potassium and calcium depletion. Muscle wasting,
weakness, osteoporosis. GI disturbances and bleeding.
Nursing Responsibilities:
• Do not give IM injections if patient has thrombocytopenic purpura.
• Rotate sites of IM repository injections to avoid local atrophy.
IV. DRUG STUDY
Generic Name: Amlodipine
Classification: Calcium Channel Blocker, Antihypertensive
Indications: Hypertension, chronic stable angina, vasospastic angina
Contraindications: Hypersensitivity to amlodipine, severe hypotension
Cautious Use: In cases of hepatic impairment, heart failure, and elderly patients
Dosage: 10 mg/tab 1 tab OD PO
Adverse Effects: Peripheral edema, flushing, headache, dizziness, hypotension
Nursing Responsibilities:
• Monitoring blood pressure, heart rate, signs of peripheral edema, and providing patient education
about potential side effects, compliance with medication regimen, and lifestyle modifications for
hypertension management.
IV. DRUG STUDY
Generic Name:Potassium Chloride
Classification: Electrolytes, Electrolyte Supplements,
Indications: used to treat and prevent low blood potassium levels
Cautious Use: Do not lie down for at least 10 minutes after taking the medication. Do not crush, chew
or suck on the tablet.
Dosage: 2 tabs
Adverse Effect: Stomach bloating, vomiting, severe stomach pain
Nursing Responsibilities:
• Administer oral drug after meals or with food and a full glass of water to decrease GI upset.
• Caution patient not to chew or crush tablets; have patient swallow tablet whole.
IV. DRUG STUDY
Generic Name: Tramadol
Classification: Analgesic
Indications: Relief of moderate to moderately severe pain
Cautious Use: acute alcoholism; head injuries; raised intracranial pressure; severe renal impairment
Dosage: 50mg IV q6h x 2doses
Adverse Effects:Sweating, dizziness, nausea, vomiting, dry mouth, fatigue, asthenia, somnolence,
confusion, constipation, flushing, headache, vertigo, tachycardia, palpitations, miosis, insomnia,
orthostatic hypotension, seizures
Nursing Responsibility:
• Control environment (temperature, lighting) if sweating or CNS effects occur.
• WARNING: Limit use in patients with past or present history of addiction to or dependence on
opioids.
IV. DRUG STUDY
Generic Name: Bisacodyl
Classification: Stimulant laxative
Indications: Expands intestinal fluid volume by increasing epithelial permeability.
Contraindications: Acute surgical abdomen, nausea, vomiting, abdominal cramps, intestinal
obstruction, fecal impaction; use of rectal suppository in presence of anal or rectal fissures, ulcerated
hemorrhoids, proctitis
Dosage: 2 tabs PO @9 PM
Adverse Effect: Mild cramping, nausea, diarrhea, fluid and electrolyte disturbances
Nursing Responsibility:
• Evaluate periodically patient’s need for continued use of drug; bisacodyl usually produces 1 or 2
soft formed stools daily.
• Monitor patients receiving concomitant anticoagulants. Indiscriminate use of laxatives results in
decreased absorption of vitamin K.
THANK YOU FOR
LISTENING