renal failure Flashcards
acute renal failure
Clinical conditions associated with rapid (days to weeks), steadily decreasing renal function (aka azotemia) with or without oliguria
causes of acute renal failure
-Hemorrhage
-Cardiomyopathy
-Septicemia
-Liver failure
-Surgery
-Malignant hypertension
-Glomerulonephritis
-Bacterial infections
-Metabolic disorders (hypercalcemia, hyperuricemia)
-MANY CAUSES
drug induced causes of acute renal failure
-NSAIDs
-Antibiotics (aminoglycosides, Vancomycin, beta-lactams, sulfonamides, Fluoroquinolones)
-amphotericin
-foscavir
-digoxin
-cyclosporine
-methotrexate
-cisplatin
-radiocontrast dye- careful with this and metformin !!!!!!!!!!
prevention of acute renal failure
-With surgery – proper maintenance of normal fluid balance, blood volume and BP
-With burns – isotonic NaCl infusion
-With hemorrhage – blood transfusion
-With nephrotoxic drugs – hydration, n-acetylcysteine, proper monitoring
acute renal failure tx
-1st hydrate and monitor then….
-Vasopressors: Dopamine LOW DOSE
-Increases renal blood flow and urine output
-kickstarts kidney
-Use lower doses for IV infusions
-shock
-Diuretics:
-Furosemide
-Mannitol- osmotic diuretic
-Electrolytes
-Dialysis- last resort
-Improves fluid and electrolyte imbalances
-Allows adequate nutrition
-Do not use in uncomplicated ARF < 5 days duration
-May need to adjust doses of all renally eliminated drugs
chronic renal failure
Clinical condition resulting from chronic derangement and insufficiency of renal excretory and regulatory function (uremia – most common cause of end stage renal disease is diabetic nephropathy)
causes of chronic renal failure
-can result from any major cause of renal dysfunction including
-Diabetic nephropathy- long standing
-Glomerulopathies
-Hereditary nephropathies (polycysitc kidney disease)
-HTN
-Obstructive uropathies
-Exacerbating factors
-Nephrotoxic drugs
-Sodium and water depletion
-Heart failure
-Infection
-Hypercalcemia
-Obstruction
management of chronic renal failure
-Delay progression (like w/ DM)
-Glycemic control
-Lipid control
-HTN control
-Reduce protein intake
-ACE inhibitors
-Diet :
-Mixed protein diet
-Increase calories if anorexic
-Vitamin supplementation w/ water soluble vitamin
-Maintain fluid and electrolyte balance:
-Hyperkalemia – treat with sodium polystyrene sulfonate (Kayexelate) cation exchange resin and will bind and excrete potassium
chronic: hyperphosphatemia
-Treat with dietary restriction of phosphate and phosphate binders
-1. calcium salts
-acetate (PhosLo)
-carbonate (Tums)
-2. aluminum salts
-hydroxide (Alternagel, Amphogel)
-3. sevelamar (Renagel)
-non-electrolyte synthetic binder (hydrogel polymer)
-Less ADRs than electrolyte binders (may cause milder gi effects)
-may also lower cholesterol
-noncompliance due to high pill burden and high cost
-4. Lanthanum carbonate (Fosrenol) – newest drug
-Lanthanum element has high affinity for phosphate
-As effective as calcium binders w/o side effects assoc w/ high dose calcium
-More studies needed to evaluate long-term effects
-expensive
chronic: metabolic acidosis
-use sodium bicarbonate to tx
chronic: anemia
-Erythropoietin alfa (Epogen, Procrit) and iron
-MOA – erythrocyte colony stimulating factor – increases maturation of RBC from the bone marrow.
-EPO depletes iron
-Monitoring parameters
-HCT
-Iron stores -> infusion
chronic: hyperparathyroidism
-secondary to renal insufficiency
-Vitamin D analogs (calcitriol) to lower PTH level and avoid bone disease
-Calcium salts
-Phosphate binders
-Cincalcet (Sensipar)
dialysis
-removing toxins directly from blood (hemodialysis) or indirectly via peritoneal fluid (peritoneal dialysis) using diffusion across a semipermeable membrane or ultrafiltration
-Indications for dialysis:
-ARF due to acute tubular necrosis (use until BUN and Creatinine normalize)
-CRF (once CRCL falls below 10 ml/min or when the patient can not maintain normal daily activity
-Uremic encephalopathy - uremic symptoms include vomiting, anorexia, fatigability and diminished sensorium, uremic signs include refractory pulmonary edema, metabolic acidosis, foot or wrist drop. These types of signs and symptoms usually necessitate urgent dialysis
-Pericarditis
-Fluid overload
-Life-threatening hyperkalemia
-Acute intoxications
-Clinical effects of dialysis:
-Remove accumulated H20 and NaCl
-Maintains electrolyte balance
-Removes toxic end products of nitrogen metabolism (urea, creatinine and uric acid)
-Corrects metabolic acidosis
-Use of Phosphate binders
-Drug supplementation – may need to adjust doses or administer supplemental doses of drugs which are renally eliminated that may be removed by hemodialysis
-may only need one pill
