Acute tubular necrosis medical therapy: Difference between revisions
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==Medical Therapy== | ==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.<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> | * Acute tubular necrosis, which is usually reversible. It may be associated with high [[morbidity]] and [[Mortality rate|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> | ||
* According to the Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines, management approach of acute tubular necrosis include, | * 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. | ** Examine all [[Patient|patients]] thoroughly to identify the [[Causes|cause]], precipitating factors, and [[Comorbidity|comorbid conditions]] leading to a rapid reduction in [[Glomerular filtration rate|GFR]], which may be reversible. | ||
** Regularly monitor patients for serum creatinine and urine output to assess the severity. | ** Regularly monitor patients for serum creatinine, BUN, and urine output to assess the severity of [[Kidney|renal]] damage. | ||
** Assess volume status and manage it accordingly. | ** Assess volume status and manage it accordingly. | ||
*** Hypovolemia: Proper hydration or isotonic saline administration can be helpful in treating volume depletion. | *** [[Hypovolemia]]: Proper hydration or isotonic saline administration can be helpful in treating [[Hypovolemia|volume depletion]]. | ||
*** Hypervolemia: The only indication of using diuretics in acute renal failure to manage volume overload status. | *** [[Hypervolemia]]: The only indication of using diuretics in [[Acute kidney injury|acute renal failure]] to manage volume overload status. | ||
** Avoiding or minimizing the dosage of nephrotoxic medications, and radiocontrast media | ** 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:<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> | ** 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> | ||
*** Diuretics except to treat hypervolemia | *** [[Diuretic|Diuretics]], except to treat hypervolemia | ||
*** Atrial natriuretic peptide | *** [[Atrial natriuretic peptide]] | ||
*** Dopamine | *** [[Dopamine]] | ||
*** Fenoldopam | *** [[Fenoldopam]] | ||
** Appropriate management of electrolyte and acid-base imbalance: | ** Appropriate management of electrolyte and acid-base imbalance: | ||
*** Hyperkalemia: Hyperkalemia is a life-threatening complication associated with acute | *** [[Hyperkalemia]]: [[Hyperkalemia]] is a life-threatening complication associated with acute tubular necrosis. | ||
**** Preferred regimen (1): Insulin (eg, intravenous injection of 10-15u of short-acting insulin) along with 50ml of dextrose | **** Preferred regimen (1): [[Insulin]] (eg, intravenous injection of 10-15u of short-acting [[insulin]]) along with 50ml of [[dextrose]]. [[Insulin]] along with [[dextrose]] may cause influx of [[potassium]] into the cell due to activation of [[Na+/K+-ATPase|sodium-potassium ATPase]]. | ||
**** Preferred regimen (2): Calcium (eg, calcium gluconate, | **** Preferred regimen (2): [[Calcium]] (eg, [[calcium gluconate]]), does not lower elevated potassium levels but, it helps to decrease myocardial contractility, thus by preventing arrythmias. | ||
**** Preferred regimen (3): Dialysis in severe and refractory cases. | **** Preferred regimen (3): [[Dialysis]] in severe and refractory cases. | ||
*** Metabolic acidosis: Sodium bicarbonate can be given to treat metabolic acidosis. | *** [[Metabolic acidosis]]: | ||
**** Preferred regimen: [[Sodium bicarbonate]] can be given to treat [[metabolic acidosis]]. | |||
** Renal replacement therapy: | ** Renal replacement therapy: | ||
*** Indications for renal replacement therapy include: | *** Indications for renal replacement therapy include: | ||
Revision as of 19:06, 19 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, BUN, and urine output to assess the severity of renal damage.
- 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 tubular necrosis.
- Preferred regimen (1): Insulin (eg, intravenous injection of 10-15u of short-acting insulin) along with 50ml of dextrose. Insulin along with dextrose may cause influx of potassium into the cell due to activation of sodium-potassium ATPase.
- Preferred regimen (2): Calcium (eg, calcium gluconate), does not lower elevated potassium levels but, it helps to decrease myocardial contractility, thus by preventing arrythmias.
- Preferred regimen (3): Dialysis in severe and refractory cases.
- Metabolic acidosis:
- Preferred regimen: Sodium bicarbonate can be given to treat metabolic acidosis.
- Hyperkalemia: Hyperkalemia is a life-threatening complication associated with acute tubular necrosis.
- Renal replacement therapy:
- Indications for renal replacement therapy include:
- Severe hyperkalemia
- Hypervolemia
- Uremia
- Severe metabolic alkalosis
- Indications for renal replacement therapy include:
References
- ↑ Finn WF (July 1990). "Diagnosis and management of acute tubular necrosis". Med. Clin. North Am. 74 (4): 873–91. PMID 2195259.
- ↑ 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.
- ↑ 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.