HRONIČNA RENALNA INSUFICIJENCIJA KOD PACIJENTA NA SUPSTITUCIONOJ TERAPIJI METADONOM

Snezana B. Knezevic; Branimir D. Dugalić; Anđelka S. Dugalić

doi:10.5937/opmed27-32733

Snezana B. Knezevic Dom zdravlja Kraljevo https://orcid.org/0000-0001-9137-2122
Branimir D. Dugalić Dom zdravlja Kraljevo
Anđelka S. Dugalić Dom zdravlja Kraljevo

DOI: https://doi.org/10.5937/opmed27-32733

Keywords: kidney damage, maintenance therapy, primary healthcare

Abstract

Introduction. Opioid addiction is a chronic condition related to different morbidities. The methadone substitution therapy of the opioid addict, combined with social, health, and psychological services is a gold standard of the treatment. All opioids display numerous side effects. Kidney damage in opioid addicts is due to sepsis, rhabdomyolysis, decreased glomerular filtration, hypotension, pulmonary edema, renal lipidosis, or amyloidosis.
Case report. The male patient, 40, on methadone substitution therapy feels weak, sweats excessively. Lab work: potassium 9.87 mmol/L, BUN 18.3 mmol/L, creatinine 268 µmol/L, urea clearance 0,20 ml/s, creatinine clearance 0,81 ml/s, eGFR 23 ml/min/1,73m2, creatine phosphokinase 1180 IU/L, Hgb 79 g/L, Er 2.81x1012/L, C-reactive protein 13.2 µg/mL, Le 7.41x109/L, PCO2 41 mmHg, HCO3 22 mmol/L, and acidosis, pH 7.21. Blood pressure 130/80 mmHg and heart rate 64 bpm, ECG shows prolonged PR interval and high T waves. He was treated with crystalloid iv solutions, 8.4% bicarbonate solutions, diuretics, calcium gluconate, shortacting insulin, antibiotics, and anticoagulants. After therapy, there is an improvement in his potassium levels, diuresis, and ECG. After 24 days of hospital treatment, he was discharged to home care.
Conclusion. Patients on methadone substitution therapy have a higher risk of multiple organ damage. Kidney function is especially at risk. It is of utmost importance to raise awareness among physicians of the danger of rabdomyolysis in these patients. Regular lab checks in patients on methadone substitution therapy can timely detect severe acute and chronic kidney complications and enable timely treatment.

Author Biography

Snezana B. Knezevic, Dom zdravlja Kraljevo

Live and work in city Kraljevo, Serbia. Graduated at the Faculty of Medicine in Kragujevac, Serbia, in 1994, the specialization in General Medicine in 2010 and full time employed a general practitioner in Health centre Kraljevo. In my team there are 1800 patients and I care about their health through preventive and curative.

The coordinator in my city for violence against women, also member of Multisector team for domestic violence. Healthcare worker Educator on Domestic violence (Population fund United Nations UNFPA Serbia). Member of the Presidency and Scientific committee of the Serbian Medical Society, General Medicine Section. Member of Editorial board of journal General practice. Writing scientific research papers, so far have 33 published. Investigated the doctor's attitude towards violence against women as well as the barrier in detecting more cases of violence against women. In 2019 became a member of the WONCA special interest group for Family Violence. I currently participate in the IMOCAFV project, supported by WONCA WORLD, WONCA EUROPE, EGPRN, EUROPREV and Vasco da Gama, translating questionnaire and forming a national team as national coordinator. Montegut scholar award winner for Wonca Europe region for 2019.

Became a member of EGPRN in 2019. and planning to take part in next EGPRN conference in Goeteborg. Reviewer for abstracts for 25^th WONCA Europe Conference in Berlin. The European Primary Care Cardiovascular Society (EPCCS) member also since 2019.

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