All Flashcards
(10 cards)
Management of a 60yo man with RAS and reduced eGFR?
Medical management - no evidence for stenting/surgery in atherosclerotic RAS
What is the strongest predictor of renal decline in glomerular diseases?
- degree of proteinuria
- BP control
- Degree of renal scarring
Proteinuria/albuminuria is predictive of CV events and all cause mortality in CKD
Management of IgA nephropathy
ACE-I/ARB if proteinuria >0.5-1g/day
Steroids controversial
Management of ANCA associated vasculitis
Rituximab (induction and maintenance)
= equivalent efficacy to Cyclophosphamide and AZA
Have shown short term benefit with plasmapheresis in renal failure or pulmonary haemorrhage, combined with Cyclophosphamide
Management of lupus nephritis
MMF (induction and maintenance)
For stage 5 lupus nephritis or CNS lupus, Cyclophosphamide
Management of membranous nephropathy?
ACE-I
Warfarin (if albumin 4g/day
3. Unexplained worsening renal function (Cr>135)
Immunosuppression: Cyclical Prednisolone and Chlorambucil/Cyclophosphamide 6 monthly
What are that benefits of renal transplant over dialysis?
- Improved long term survival (Tx > dialysis)
- Improved QOL: independence from dialysis and fluid restriction, overseas travel, work, feel better
- Cheaper after the 1st year
Absolute risk of ESRF after renal transplant is low compared to the general population, though relative risk in transplant patients is higher than the population
What is the management of hyperphosphataemia in CKD?
- Phosphate binders
- take WITH food
- don’t phosphate restrict in the diet - Extend dialysis time (PO4 removal is TIME dependent)
X calcitriol - 1,25-OH vit D reduces PTH secretion but increases GI absorption of Ca and PO4
What is the action of calcimimetics (Cinacalcet)?
Decreases PTH level by tricking CaSR, thus decreases Ca level (variable effect on PO4)
Management of single RAS in a young patient with slightly reduced renal function?
Angioplasty and stenting
