role of pharmacist in management of kidney stones from recurrent uti
TRANSCRIPT
PHARMACIST ROLE IN
MANAGEMENT OF
KIDNEY STONES FROM RECURRENT
UTI
Kidney stone disease, also known as urolithiasis, is when a solid piece of material in kidney (kidney stone) occurs in urinary tract.Kidney stones affect all geographical, cultural, and racial groups. The lifetime risk about 10 to 15% in the world.
Types of kidney stones: Calcium stones(80%) Uric acid stones (9%)Straiten stones (<10%)Cysteine stones (<1%)
INTRODUCTION
Causes of kidney stones:Inadequate fluid intake and urine outputRegular constipationIncreased salt intakeGeneticAutosomal recessive genetical disorderMetabolic disorders: GOUT Diabetes Blood pressure Inflammatory bowel diseaseDrugs that promote kidney stone formation Increased drug concentration in urine: Acyclovir, Allopurinol, Aminopencilins, Ceftriaxone, Ciprofloxacine Altered urine pH and composition Antiepileptics,Ca containing drugs, Vitamin c , Carbonic anhydrase inhibitor, Vitamin D
Pharmacist should take special care in these cases.
Risk factorsAge Twice in men than women Men after age 40 Women during 50 Tinge girls have higher risksGenderRaceInadequate fluid intake and urine output promote urineConcentrationEating habitsAlcohol consumption SmokingEmotional statusExercisePulmonary ventilation Dietary habits
Why kidney stones can be problem?Stones pass from the kidney to the ureters. ureter is small and delicate stone may be to large to pass smoothly the ureter can cause spasms and irritation. Which causes blood in urine some times stones block the flow of urine leads to kidney damage.
Which stones are most likely to pass with out surgery Smaller the stone and the more distal its location the more likely it will pass spontaneously If the stone size 2-4mm in diameter to pass in approximately 13days.If the stone size 6-8mm in diameter to pass in approximately 22days
ATYPICAL HISTORY OF UTERIC STONE CASE HISTORY20years oldFemaleFew twinges over 11 months with pain at flank region.UTI was observed 4 times before the kidney stones.Ultra sound scanning showed renal calculi 4mm diameter in right kidney with mild nephrosis.After the kidney stone, Again reoccurrence of urinary tract infection was observed.
CASE STUDY WITH RENAL CALCULI
Reoccurence is due to lack of pharmacist at hospital and pharmacy in this case study.
ON 09-05-2015Increased eosinophilsURINARY TRACT INFECTION
ON 12-05-2015Organism is E-COLIWith UTI
Patient is admitted with severe flank pain, frequent urination, pain during urination.UTI was identified and micro-organism was E-COLI antibiotics are prescribed
ON 08/10/2015 Increase in Eosinophils
ON 08/09/2015Mild hydronephrosisCystitis is identified.
Patient is admitted with same symptoms again to the hospital with UTI Reason: Incomplete course of tablets, Inadequate water intake.Due to lack of counseling, no awareness in use of antibiotics by pharmacist.
ON 22-01-16 The patient admitted with severe flank pain, abdominal pain, headache, nausea, haematuria.By Diagnosis: Right renal calculi with mild hydronephrosis is found.
UTI is progressed to renal caluculus
ON 11-05-2016 CYSTITIS is observed
ON 29-07-2016Mild hydronephrosisCystitis is observed.
After renal calculi UTI is again observed.
THIS CASE CAN BE PREVENTED BY PROPER PHARMACIST COUNSELING
CEFTRIAXONE(500mg), DOLO 650, VOVERON, PANTAC, MONOCEF For 5 days
TREATMENT TO PATIENT
ON 09-05-2015Increased eosinophilsURINARY TRACT INFECTIONOrganism is E-COLI
ON 08/09/2015Mild hydronephrosisCystitis is identified.
ON 08/10/2015 Increase in Eosinophils
On First Admission :
On Second Admission: CEFTRIAXONE(500mg)AZITHROMYCIN(250mg) DOLO 650, VOVERON, PANTAC.
OFLAXCICIN(200mg) DOLO 650, VOVERON, PANTAC, MONOCEF
On third Admission:
URIKIND,DOLO 650,VOVERON, PANTAC,MONOCEF AMOXICILLIN (500mg) CIPROFLOXICIN-Im
ON 22-01-16Right renal calculi with mild hydronephrosis is found.
On sixth Admission:
ON 11-05-2016 CYSTITIS is observed
ON 29-07-2016Mild hydronephrosisCystitis is observed.
AMOXICILLLIN WITH CLAVUNOIC ACID(650mg) DOLO 650,VOVERON, PANTAC,MONOCEF
On fifth Admission:
On fourth Admission:
NITROFURANTOIN,DOLO 650,VOVERON, PANTAC,MONOCEF
Lack of patient counseling.Lack of medication adherence.Lack of awareness regarding antibiotic
résistance.No rational use of drugs. prescription of high power antibiotics.Maintenance of unhygienic condition.
Reasons of patient reoccurrence
Patient counseling for renal calculi patients:• In prevention of disease•Counseling patients on discharge•Regarding non-pharmacological therapy•Drugs to be avoided•Foods to be avoided•Life style modifications.
PHARMACIST SHOULD PROVIDE INFORMATION ON NON PHARMACOLOGICAL THERAPY Foods to be avoided: Potato chips, peanuts chocolate spinach, Asparagus, Beetroot,Rhubarb,Chocolate,BerriesLeeks,Parsley,CeleryAlmonds,Peanuts, Cashew nut, Soy products, Grains such as oat meal, Whole wheat.
Plenty of water intake Decreased salt intake Maintain healthy diet Avoiding fructose containing soft drinks Avoid calcium containing food: Meat, Poultry, fish.
Due to lack of pharmacist In this case study the results are:
Drug drug interaction between trimethoprim and acetaminophen and leads to increased side effects.
Chance of renal calculi again
Drug which increases kidney stone is used: ceftriaxone increases risk of kidney stone.
Development of antibiotic resistance
Reoccurence of UTI: Due to lack of medication non adherence.reoccurrence with same micro organism occurs.
Preventive measures to be counseled by pharmacist to patient :The best way of preventing kidney stones is to make sure to drink plenty of water each day to avoid becoming dehydration.Reducing salt intakeMaintain a healthy dietAvoid fructose containing soft drinksPatient dietary calcium intake 700-1000mg per day.For patient urate stones reduce dietary purine rich protein like red meat,sea food,fish,animal protein.For patient calcium stones reducing eating oxalate rich food like potato chips, pear nuts,chocolate,beets,spinach.To maintaining healthy exercise.Awareness about the kidney stone formation to the people
The patient should be well counseled about preventive measures to prevent reoccurrence of UTI and Kidney stones.Counseling about non pharmacological therapyCreating awareness about Antibiotic resistance and Importance of medication adherenceCounseling about Drug Information and their usage along with drug.
Pharmacist is in ideal position
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REFERENCES
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