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==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
* Acute tubular necrosis, which is usually reversible. It may be associated with high morbidity and mortality, early recognition and management are essential for a better outcome.<ref name="pmid2195259">{{cite journal |vauthors=Finn WF |title=Diagnosis and management of acute tubular necrosis |journal=Med. Clin. North Am. |volume=74 |issue=4 |pages=873–91 |date=July 1990 |pmid=2195259 |doi= |url=}}</ref>
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
* According to the Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines, management approach of acute tubular necrosis include,
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
** Examine all patients thoroughly to identify the cause, precipitating factors, and comorbid conditions leading to a rapid reduction in GFR, which may be reversible.
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
** Regularly monitor patients for serum creatinine and urine output to assess the severity.
===Disease Name===
** Assess volume status and manage it accordingly.
 
*** Hypovolemia: Proper hydration or isotonic saline administration can be helpful in treating volume depletion.
* '''1 Stage 1 - Name of stage'''
*** Hypervolemia: The only indication of using diuretics in acute renal failure to manage volume overload status.
** 1.1 '''Specific Organ system involved 1'''
** Avoiding or minimizing the dosage of nephrotoxic medications, and radiocontrast media
*** 1.1.1 '''Adult'''
** According to KDIGO guidelines, following medications have no role in the management and outcome of acute tubular necrosis:<ref name="pmid11505120">{{cite journal |vauthors=Kellum JA, M Decker J |title=Use of dopamine in acute renal failure: a meta-analysis |journal=Crit. Care Med. |volume=29 |issue=8 |pages=1526–31 |date=August 2001 |pmid=11505120 |doi= |url=}}</ref><ref name="pmid17352669">{{cite journal |vauthors=Bagshaw SM, Delaney A, Haase M, Ghali WA, Bellomo R |title=Loop diuretics in the management of acute renal failure: a systematic review and meta-analysis |journal=Crit Care Resusc |volume=9 |issue=1 |pages=60–8 |date=March 2007 |pmid=17352669 |doi= |url=}}</ref>
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
*** Diuretics except to treat hypervolemia
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
*** Atrial natriuretic peptide
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
*** Dopamine
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
*** Fenoldopam
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
** Appropriate management of electrolyte and acid-base imbalance:
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** Hyperkalemia: Hyperkalemia is a life-threatening complication associated with acute renal failure.  
*** 1.1.2 '''Pediatric'''
**** Preferred regimen (1): Insulin (eg, intravenous injection of 10-15u of short-acting insulin) along with 50ml of dextrose will lead to a shift of potassium ions into cells, secondary to increased activity of the sodium-potassium ATPase.
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
**** Preferred regimen (2): Calcium (eg, calcium gluconate, preferably through a central venous catheter as the calcium may cause phlebitis) does not lower potassium but decreases myocardial excitability, protecting against life-threatening arrhythmias.
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
**** Preferred regimen (3): Dialysis in severe and refractory cases.
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
*** Metabolic acidosis:  
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
 
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days  
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 20:27, 1 June 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]

Overview

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Medical Therapy

  • Acute tubular necrosis, which is usually reversible. It may be associated with high morbidity and mortality, early recognition and management are essential for a better outcome.[1]
  • According to the Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines, management approach of acute tubular necrosis include,
    • Examine all patients thoroughly to identify the cause, precipitating factors, and comorbid conditions leading to a rapid reduction in GFR, which may be reversible.
    • Regularly monitor patients for serum creatinine and urine output to assess the severity.
    • Assess volume status and manage it accordingly.
      • Hypovolemia: Proper hydration or isotonic saline administration can be helpful in treating volume depletion.
      • Hypervolemia: The only indication of using diuretics in acute renal failure to manage volume overload status.
    • Avoiding or minimizing the dosage of nephrotoxic medications, and radiocontrast media
    • According to KDIGO guidelines, following medications have no role in the management and outcome of acute tubular necrosis:[2][3]
      • Diuretics except to treat hypervolemia
      • Atrial natriuretic peptide
      • Dopamine
      • Fenoldopam
    • Appropriate management of electrolyte and acid-base imbalance:
      • Hyperkalemia: Hyperkalemia is a life-threatening complication associated with acute renal failure.
        • Preferred regimen (1): Insulin (eg, intravenous injection of 10-15u of short-acting insulin) along with 50ml of dextrose will lead to a shift of potassium ions into cells, secondary to increased activity of the sodium-potassium ATPase.
        • Preferred regimen (2): Calcium (eg, calcium gluconate, preferably through a central venous catheter as the calcium may cause phlebitis) does not lower potassium but decreases myocardial excitability, protecting against life-threatening arrhythmias.
        • Preferred regimen (3): Dialysis in severe and refractory cases.
      • Metabolic acidosis:

References

  1. ↑ Finn WF (July 1990). "Diagnosis and management of acute tubular necrosis". Med. Clin. North Am. 74 (4): 873–91. PMID 2195259.
  2. ↑ Kellum JA, M Decker J (August 2001). "Use of dopamine in acute renal failure: a meta-analysis". Crit. Care Med. 29 (8): 1526–31. PMID 11505120.
  3. ↑ Bagshaw SM, Delaney A, Haase M, Ghali WA, Bellomo R (March 2007). "Loop diuretics in the management of acute renal failure: a systematic review and meta-analysis". Crit Care Resusc. 9 (1): 60–8. PMID 17352669.

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