Chronic renal failure primary prevention: Difference between revisions

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Created page with "{{Chronic renal failure}} {{CMG}} {{AE}} {{AN}} ==Treatment of Reversible Exacerbants== * Volume Depletion ** May be subtle ** Autoregulation impaired with DM, [[hypert..."
 
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{{CMG}} {{AE}} {{AN}}
{{CMG}} {{AE}} {{AN}}


==Treatment of Reversible Exacerbants==
== Overview ==


* Volume Depletion
== Primary Prevention ==
** May be subtle
Effective measures for the primary prevention of chronic renal failure include:
** Autoregulation impaired with [[DM]], [[hypertension]], CRI--decreases [[GFR]] with mild volume depletion  
* Treatment of reversible exacerbants
*** Careful trial of volume repletion may--return of baseline renal function  
** Volume Depletion
** (Increase dietary Na, reduce [[diuretic]] dosing)
*** May be subtle
* [[Nephrotoxicity|Nephrotoxin]]s
*** Autoregulation impaired with [[DM]], [[hypertension]], CRI--decreases [[GFR]] with mild volume depletion  
** [[NSAIDS]]
**** Careful trial of volume repletion may--return of baseline renal function  
*** Most toxic in setting of volume depletion, [[CHF]], [[diuretic]] use
*** (Increase dietary Na, reduce [[diuretic]] dosing)
*** Reduce [[prostaglandin]] (PG) synthesis--unopposed vasoconstriction with decreased GFR
** [[Nephrotoxicity|Nephrotoxin]]s
*** Can also cause ATN ([[acute tubular necrosis]])
*** [[NSAIDS]]
**[[Aminoglycoside]]s  
**** Most toxic in setting of volume depletion, [[CHF]], [[diuretic]] use
*** Nonoliguric [[ARF]] typically occurs at 7-10 days  
**** Reduce [[prostaglandin]] (PG) synthesis--unopposed vasoconstriction with decreased GFR
*** Increased risk with older patients, prolonged therapy and greater total dose
**** Can also cause ATN ([[acute tubular necrosis]])
** [[Radiocontrast|IV contrast]]
***[[Aminoglycoside]]s  
*** [[ARF]] usually occurs within 24-48 hours of dye administration
**** Nonoliguric [[ARF]] typically occurs at 7-10 days  
*** Peak Cr after 5-7 days with return to baseline at 10-14 days
**** Increased risk with older patients, prolonged therapy and greater total dose
*** Risk [[ARF]] increased with [[DM]] and higher volume of dye
*** [[Radiocontrast|IV contrast]]
*** 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
**** [[ARF]] usually occurs within 24-48 hours of dye administration
* Urinary Tract Obstruction
**** Peak Cr after 5-7 days with return to baseline at 10-14 days
*** Most commonly due to [[Benign prostatic hypertrophy|prostatic hypertrophy]] in men  
**** 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
** Urinary Tract Obstruction
*** Most commonly due to [[Benign prostatic hypertrophy|prostatic hypertrophy]] in men
** Other causes:   
** Other causes:   
*** [[Nephrolithiasis]]  
*** [[Nephrolithiasis]]  
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*** Results in reduced [[GFR]] and impaired tubular function
*** Results in reduced [[GFR]] and impaired tubular function
*** Consider [[ultrasound]], urologic evaluation
*** Consider [[ultrasound]], urologic evaluation





Revision as of 19:15, 6 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]

Overview

Primary Prevention

Effective measures for the primary prevention of chronic renal failure include:


References

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