Acute tubular necrosis medical therapy
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Acute tubular necrosis Microchapters |
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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.
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[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].
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Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
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Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
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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.