Chronic renal failure medical therapy: Difference between revisions
No edit summary |
No edit summary |
||
| Line 4: | Line 4: | ||
==Overview== | ==Overview== | ||
Treatment is aimed at specific causes of [[chronic renal failure]]. It includes optimized glucose levels in patients with [[diabetes]], management of [[blood pressure]], [[immunomodulators]] for [[glomerulonephritis]], emerging specific therapies to retard cytogenesis in [[polycystic kidney disease]] and replacement of critical hormones and chemicals produced and utilized by normally healthy [[kidneys]]. Any acceleration in the disease process should prompt a search for superimposed acute or subacute disease process that is potentially reversible. These include extravascular fluid volume depletion, [[urinary tract infection]], [[obstructive uropathy]], exposure to [[nephrotoxicity|nephrotoxic agents]] such as [[NSAIDs]] or [[radiocontrast]]s, re-activation and flare of the primary disease like [[SLE]] or [[vasculitis]]. | |||
==Blood pressure management== | ==Blood pressure management== | ||
The goal of therapy is to slow down or halt the otherwise relentless progression of CRF | The goal of therapy is to slow down or halt the otherwise relentless progression of CRF. Control of [[blood pressure]] and treatment of the original disease, whenever feasible, are the broad principles of management. Generally, [[angiotensin converting enzyme inhibitor]]s (ACEIs) or angiotensin II receptor antagonists (ARBs) are used, as they have been found to slow the progression to ESRD.<ref>Ruggenenti P, Perna A, Gherardi G, Gaspari F, Benini R, Remuzzi G. Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy. Lancet. 1998 Oct 17;352(9136):1252-6. PMID 9788454.</ref><ref>Ruggenenti P, Perna A, Gherardi G, Garini G, Zoccali C, Salvadori M, Scolari F, Schena FP, Remuzzi G. Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet. 1999 Jul 31;354(9176):359-64. PMID 10437863.</ref> | ||
==Chemical replacement therapy== | ==Chemical replacement therapy== | ||
Revision as of 19:40, 1 August 2012
|
Chronic renal failure Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Chronic renal failure medical therapy On the Web |
|
American Roentgen Ray Society Images of Chronic renal failure medical therapy |
|
Risk calculators and risk factors for Chronic renal failure medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]
Overview
Treatment is aimed at specific causes of chronic renal failure. It includes optimized glucose levels in patients with diabetes, management of blood pressure, immunomodulators for glomerulonephritis, emerging specific therapies to retard cytogenesis in polycystic kidney disease and replacement of critical hormones and chemicals produced and utilized by normally healthy kidneys. Any acceleration in the disease process should prompt a search for superimposed acute or subacute disease process that is potentially reversible. These include extravascular fluid volume depletion, urinary tract infection, obstructive uropathy, exposure to nephrotoxic agents such as NSAIDs or radiocontrasts, re-activation and flare of the primary disease like SLE or vasculitis.
Blood pressure management
The goal of therapy is to slow down or halt the otherwise relentless progression of CRF. Control of blood pressure and treatment of the original disease, whenever feasible, are the broad principles of management. Generally, angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor antagonists (ARBs) are used, as they have been found to slow the progression to ESRD.[1][2]
Chemical replacement therapy
Replacement of erythropoietin and vitamin D3, two hormones processed by the kidney, is usually necessary along with calcium supplementation. Phosphate binders are used to control the serum phosphate levels, which are usually elevated in chronic renal failure.
After ESRD occurs, renal replacement therapy is required, in the form of either dialysis or a transplant.
References
- ↑ Ruggenenti P, Perna A, Gherardi G, Gaspari F, Benini R, Remuzzi G. Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy. Lancet. 1998 Oct 17;352(9136):1252-6. PMID 9788454.
- ↑ Ruggenenti P, Perna A, Gherardi G, Garini G, Zoccali C, Salvadori M, Scolari F, Schena FP, Remuzzi G. Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet. 1999 Jul 31;354(9176):359-64. PMID 10437863.