Premium
Complex prescribing in chronic kidney disease: role of the renal pharmacist in kidney supportive care in uncovering hydralazine‐related lupus
Author(s) -
Scuderi Carla E.,
Berquier Ilse R.,
Purtell Louise A.,
Bonner Ann J.,
Douglas Carol M.,
Healy Helen G.
Publication year - 2019
Publication title -
journal of pharmacy practice and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.222
H-Index - 22
eISSN - 2055-2335
pISSN - 1445-937X
DOI - 10.1002/jppr.1520
Subject(s) - medicine , hydralazine , hydroxychloroquine , pharmacist , context (archaeology) , renal function , systemic lupus erythematosus , intensive care medicine , kidney disease , polypharmacy , disease , blood pressure , pharmacy , nursing , infectious disease (medical specialty) , covid-19 , paleontology , biology
Abstract Background Herein we describe the presentation of drug‐induced lupus in an 89‐year‐old woman with end‐stage kidney disease (estimated glomerular filtration rate (eGFR) 11 mL/min per 1.73 m 2 ) who had chosen a conservative non‐dialysis pathway of care, and highlight the role of a pharmacist in identifying drug‐related problems. Clinical details Among numerous health conditions, the patient had systemic lupus erythematosus (SLE) that had previously responded to hydroxychloroquine, which had been ceased. Hydralazine was subsequently commenced to control the patient's blood pressure. The combination of ceasing the medicine that controlled the patient's SLE and commencing a medicine that accumulates in patients with reduced renal function and can precipitate SLE resulted in a reactivation of the patient's disease. Outcomes The pharmacist was pivotal in uncovering the timeline of medication changes and assisting in identifying SLE reactivation. Cessation of the patient's hydralazine and recommencing hydroxychloroquine resulted in the resolution of the symptoms. Conclusion This case presents the value of an interdisciplinary approach to patient directed symptoms, when prescribing in the very complex clinical context of multiple comorbid conditions for patients with severely reduced renal function.