Chronic renal failure primary prevention: Difference between revisions
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{{Chronic renal failure}} | {{Chronic renal failure}} | ||
{{CMG}} {{AE}} {{AN}} | {{CMG}};{{AE}}:{{AN}},{{SSW}} | ||
== Overview == | == Overview == | ||
Effective measures for the primary prevention of chronic renal failure include treatment of reversible exacerbants such as [[volume depletion]], [[Nephrotoxicity|nephrotoxins]], [[urinary tract obstruction]] and other causes. | |||
== Primary Prevention == | == Primary Prevention == | ||
Effective measures for the primary prevention of chronic renal failure include: | Effective measures for the primary prevention of chronic renal failure include:<ref name="pmid16148593">{{cite journal |vauthors=Zandi-Nejad K, Brenner BM |title=Primary and secondary prevention of chronic kidney disease |journal=J. Hypertens. |volume=23 |issue=10 |pages=1771–6 |date=October 2005 |pmid=16148593 |doi= |url=}}</ref> | ||
* Treatment of reversible exacerbants | * Treatment of reversible exacerbants | ||
** Volume Depletion | ** Volume Depletion | ||
| Line 17: | Line 18: | ||
**** Reduce [[prostaglandin]] (PG) synthesis--unopposed vasoconstriction with decreased GFR | **** Reduce [[prostaglandin]] (PG) synthesis--unopposed vasoconstriction with decreased GFR | ||
**** Can also cause ATN ([[acute tubular necrosis]]) | **** Can also cause ATN ([[acute tubular necrosis]]) | ||
***[[Aminoglycoside]]s | ***[[Aminoglycoside]]s<ref name="pmid89104">{{cite journal |vauthors=Ogborne A, Collier D |title=A rehabilitation programme with a controlled drinking option |journal=Int J Soc Psychiatry |volume=25 |issue=1 |pages=47–55 |date=1979 |pmid=89104 |doi=10.1177/002076407902500107 |url=}}</ref> | ||
**** Nonoliguric [[ARF]] typically occurs at 7-10 days | **** Nonoliguric [[ARF]] typically occurs at 7-10 days | ||
**** Increased risk with older patients, prolonged therapy and greater total dose | **** Increased risk with older patients, prolonged therapy and greater total dose | ||
| Line 25: | Line 26: | ||
**** Risk [[ARF]] increased with [[DM]] and higher volume of dye | **** Risk [[ARF]] increased with [[DM]] and higher volume of dye | ||
**** Note: certain meds increase [[Creatinine|serum Cr]] (via inhibiting Cr secretion or interfering with assay) without changing [[GFR]], e.g. [[cimetidine]], [[trimethoprim]] (TMP), [[cefoxitin]], [[flucytosine]]; [[BUN]] will not rise because [[GFR]] is preserved | **** Note: certain meds increase [[Creatinine|serum Cr]] (via inhibiting Cr secretion or interfering with assay) without changing [[GFR]], e.g. [[cimetidine]], [[trimethoprim]] (TMP), [[cefoxitin]], [[flucytosine]]; [[BUN]] will not rise because [[GFR]] is preserved | ||
** Urinary | ** Urinary tract obstruction<ref name="pmid12086196">{{cite journal |vauthors=Roth KS, Koo HP, Spottswood SE, Chan JC |title=Obstructive uropathy: an important cause of chronic renal failure in children |journal=Clin Pediatr (Phila) |volume=41 |issue=5 |pages=309–14 |date=June 2002 |pmid=12086196 |doi=10.1177/000992280204100503 |url=}}</ref> | ||
*** Most commonly due to [[Benign prostatic hypertrophy|prostatic hypertrophy]] in men | *** Most commonly due to [[Benign prostatic hypertrophy|prostatic hypertrophy]] in men | ||
** Other causes: | ** Other causes: | ||
*** [[Nephrolithiasis]] | *** [[Nephrolithiasis]] | ||
*** [[Tumor]] | *** [[Tumor]] | ||
*** [[Neurogenic bladder]] | *** [[Neurogenic bladder]]<ref name="pmid28035730">{{cite journal |vauthors=Sung BM, Oh DJ, Choi MH, Choi HM |title=Chronic kidney disease in neurogenic bladder |journal=Nephrology (Carlton) |volume=23 |issue=3 |pages=231–236 |date=March 2018 |pmid=28035730 |doi=10.1111/nep.12990 |url=}}</ref> | ||
*** Results in reduced [[GFR]] and impaired tubular function | *** Results in reduced [[GFR]] and impaired tubular function | ||
*** Consider [[ultrasound]], urologic evaluation | *** Consider [[ultrasound]], urologic evaluation | ||
Latest revision as of 19:22, 6 August 2018
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Risk calculators and risk factors for Chronic renal failure primary prevention |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: :Aarti Narayan, M.B.B.S [2],Sargun Singh Walia M.B.B.S.[3]
Overview
Effective measures for the primary prevention of chronic renal failure include treatment of reversible exacerbants such as volume depletion, nephrotoxins, urinary tract obstruction and other causes.
Primary Prevention
Effective measures for the primary prevention of chronic renal failure include:[1]
- Treatment of reversible exacerbants
- Volume Depletion
- May be subtle
- Autoregulation impaired with DM, hypertension, CRI--decreases GFR with mild volume depletion
- Careful trial of volume repletion may--return of baseline renal function
- (Increase dietary Na, reduce diuretic dosing)
- Nephrotoxins
- NSAIDS
- Most toxic in setting of volume depletion, CHF, diuretic use
- Reduce prostaglandin (PG) synthesis--unopposed vasoconstriction with decreased GFR
- Can also cause ATN (acute tubular necrosis)
- Aminoglycosides[2]
- Nonoliguric ARF typically occurs at 7-10 days
- Increased risk with older patients, prolonged therapy and greater total dose
- IV contrast
- ARF usually occurs within 24-48 hours of dye administration
- Peak Cr after 5-7 days with return to baseline at 10-14 days
- Risk ARF increased with DM and higher volume of dye
- Note: certain meds increase serum Cr (via inhibiting Cr secretion or interfering with assay) without changing GFR, e.g. cimetidine, trimethoprim (TMP), cefoxitin, flucytosine; BUN will not rise because GFR is preserved
- NSAIDS
- Urinary tract obstruction[3]
- Most commonly due to prostatic hypertrophy in men
- Other causes:
- Nephrolithiasis
- Tumor
- Neurogenic bladder[4]
- Results in reduced GFR and impaired tubular function
- Consider ultrasound, urologic evaluation
- Volume Depletion
References
- ↑ Zandi-Nejad K, Brenner BM (October 2005). "Primary and secondary prevention of chronic kidney disease". J. Hypertens. 23 (10): 1771–6. PMID 16148593.
- ↑ Ogborne A, Collier D (1979). "A rehabilitation programme with a controlled drinking option". Int J Soc Psychiatry. 25 (1): 47–55. doi:10.1177/002076407902500107. PMID 89104.
- ↑ Roth KS, Koo HP, Spottswood SE, Chan JC (June 2002). "Obstructive uropathy: an important cause of chronic renal failure in children". Clin Pediatr (Phila). 41 (5): 309–14. doi:10.1177/000992280204100503. PMID 12086196.
- ↑ Sung BM, Oh DJ, Choi MH, Choi HM (March 2018). "Chronic kidney disease in neurogenic bladder". Nephrology (Carlton). 23 (3): 231–236. doi:10.1111/nep.12990. PMID 28035730.