Dialysis chronic renal failure

A 30-year-old male with a two-year history of chronic renal failure requiring dialysis consents to transplantation. A donor kidney becomes available. He is given cyclosporine to prevent transplant rejection just before surgery What is the most likely adverse effect of this drug ... 

M34. Murphy, B. G., McNamee, P., Duly, E., Henry, W., Archbold, P., and Trinick, T., Increased serum apolipoprotein(a) in patients with chronic renal failure treated with continuous ambulatory peritoneal dialysis. Atherosclerosis (Shannon, Irel.) 93, 53-57 (1992). 

Slow IV injection In chronic renal failure patients, iron sucrose may be administered by slow IV injection into the dialysis line at a rate of 1 ml (20 mg iron) undiluted solution per minute (ie, 5 min/vial) not exceeding 1 vial of iron sucrose (100 mg elemental iron) per injection. Discard any unused portion. 

Treatment of anemia associated with chronic renal failure (CRF) n adults and children 1 month of age and older, treatment of anemia associated with CRF, including patients on dialysis (end-stage renal disease) and patients not on dialysis, to elevate or maintain the red blood cell level (as manifested by the hematocrit or hemoglobin determinations) and to decrease the need for transfusions. Nondialysis patients with symptomatic anemia considered for therapy should have a hemoglobin less than 10 g/dL. Not intended for patients who require immediate correction of... 

Anemia For the treatment of anemia associated with chronic renal failure (CRF), including patients on dialysis, and for the treatment of anemia in patients with nonmyeloid malignancies. 

Chronic renal failure/dialysis During sucralfate administration, small amounts of aluminum are absorbed. Concomitant use with other aluminum-containing products may increase the total body burden of aluminum. Patients with chronic renal failure or receiving dialysis have impaired excretion of absorbed aluminum, and aluminum is not dialyzed. Aluminum accumulation and toxicity have occurred. 

However, in patients with renal failure there is a strange and currently unexplained observation in relation to non-renal clearance. If this is measured for some compounds it also is found to be depressed even though it is the kidney that is diseased and not the liver The picture becomes a little clearer if the same non-renal (presumed hepatic) clearance is measured again in patients after renal dialysis when the hepatic clearance has been found to have risen to control values. Recent animal experiments have demonstrated that the circulating inhibitor of hepatic cytochrome P450 may be parathyroid hormone. Parathyroidectomy of rats with chronic renal failure prevented the reduction in liver cytochrome activity (see Michaud et al., 2006). 

Hyperkalemia occurs occasionally in patients with chronic renal failure, usually in those who do not conform fo medication regimen, dietary guidelines, and frequency of dialysis regimen. 

E. Therapeutic response Epoetin alfa has been shown to stimulate erythropoiesis in anemic patients with chronic renal failure, including both patients on dialysis and those who do not require regular dialysis. The hrst evidence of a response to the administration of epoetin alfa is an increase in the reticulocyte count within 10 days, followed by increases in the red cell count, hemoglobin, and hematocrit, usually within 2 to 6 weeks. Once the hematocrit reaches the suggested target range (30-36%), that level can be sustained by epoetin alfa therapy. 

E. Therapeutic response Two studies have evaluated the efficacy of darbepoetin for the correction of anemia in adult patients with chronic renal failure. In one study, the hemoglobin target was reached by 72% of dialysis patients treated with darbepoetin and 84% treated with recombinant erythropoietin. In the other, the primary end point was achieved by 93% of predialysis patients treated with darbepoetin and 92% of patients treated with recombinant erythropoietin. 

The choice of vitamin D preparation to be used in the setting of chronic renal failure in the dialysis patient depends on the type and extent of bone disease and hyperparathyroidism. No consensus has been reached regarding the advisability of using any vitamin D metabolite in the predialysis patient. l,25(OH)2D3 (calcitriol) will rapidly correct hypocalcemia and at least partially reverse the secondary hyperparathyroidism and osteitis fibrosa. Many patients with muscle weakness and bone pain gain an improved sense of well-being. 

Steinman MA, Steinman TI. Clarithromycin-associated visual hallucinations in a patient with chronic renal failure on continuous ambulatory peritoneal dialysis. Am J Kidney Dis 1996 27(l) 143-6. 

P. Z. lungers, A. Massy, T. K. Nguyen, C. Fumeron, M. Labrunie, B. Lacour, B. Descamps-Latscha and N. K. Man, Incidence and Risk factors of Atherosclerotic Cardiovascular Accidents in Predialysis Chronic Renal Failure Patients A Prospective Study, Nephrology Dialysis and Transplantation 12 (1997) 2597- 2602. 

Chronic renal failure Is treated by dialysis, kidney transplants, and drugs, as well as by Sow-protein diets. For tlris reason, an outline of chronic renal failure occurs in this chapter. The normal giomernlar filtration rate (GFR) is 80 to 120 ml/min. In severe renal disease, the GFR can be reduced to 10 ml/min or less. This represents a 90% loss of renal function. Diabetes mellitus and hypertension thigh blood pressure) are the main causes of chronic renal failure. Sustained and chronic injury to the kidneys leads to the destruction of the nephrons, where this destruction is usually not reversible. The nephron, which is the sm a I lest unit of kidney function, isdtjtailEd in the section on dium, Potassium, Chloride, and Water. The severe loss of nephrons results in alterations of functions of many other organs of the body. The collechon of abnormalities that results is called uremia. 

Sulkova S, Valek A. Aluminium elimination in patients receiving regular dialysis treatment for chronic renal failure. Trace Elem Med 1991 8(Suppl l) 26-30. 

Critchley JA, Critchley LA. Digoxin toxicity in chronic renal failure treatment by multiple dose activated charcoal intestinal dialysis. Hum Exp Toxicol 1997 16(12) 733-5. 

Since toxin induced chronic renal failure is theorized to occur after years of low-level toxin exposure, it stands to reason that the incidence would be clustered in elderly patients. The study of Chester et al. [172] provides indirect support that elderly patients may be at greater risk. Of the 79 patients with chronic renal failure who met age criteria of 70 year or more, 29% were classified as having chronic interstitial nephritis, a clinical diagnosis quite compatible with toxin induced renal failure and an incidence substantially higher than the 10.4% in accumulated series in which patients 50 year and older were included [173]. Furthermore, in the 2006 USRDS survey of causes of ESRD, the average age for patients with a diagnosis of interstitial nephropathy was 56 year compared to 58 years for the entire population reported [119]. In the recent analysis of the PICARD database, advanced age was associated with increased mortahty in AKI patients both at time of consultation and after initiation of dialysis treatment [38]. 

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