Chronic renal failure primary prevention: Difference between revisions
Jump to navigation
Jump to search
Created page with "{{Chronic renal failure}} {{CMG}} {{AE}} {{AN}} ==Treatment of Reversible Exacerbants== * Volume Depletion ** May be subtle ** Autoregulation impaired with DM, [[hypert..." |
Sargun Walia (talk | contribs) |
||
| Line 2: | Line 2: | ||
{{CMG}} {{AE}} {{AN}} | {{CMG}} {{AE}} {{AN}} | ||
== | == 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]] | ||
| Line 30: | Line 33: | ||
*** 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
|
Chronic renal failure Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Chronic renal failure primary prevention On the Web |
|
American Roentgen Ray Society Images of Chronic renal failure primary prevention |
|
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]
Overview
Primary Prevention
Effective measures for the primary prevention of chronic renal failure include:
- 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
- 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
- Most commonly due to prostatic hypertrophy in men
- Other causes:
- Nephrolithiasis
- Tumor
- Neurogenic bladder
- Results in reduced GFR and impaired tubular function
- Consider ultrasound, urologic evaluation
- Volume Depletion