Nephropathy prevention

Lameier NH. Contrast-induced nephropathy—prevention and risk reduction. Nephrol... 

Diabetic nephropathy prevention of kidney failure PO 25 mg 3 times a day Dosage in renal impairment Creatinine clearance 10-50 ml/min. 75% of normal dosage. Creatinine clearance less than 10 ml/min. 50% of normal dosage. 

Treatment of chronic gouty arthritis, Half-life uric acid nephropathy. Prevents or 2-3 hours... 

In the treatment of hypertension, ACE inhibitors are as effective as diuretics, (3-adrenoceptor antagonists, or calcium channel blockers in lowering blood pressure. However, increased survival rates have only been demonstrated for diuretics and (3-adrenoceptor antagonists. ACE inhibitors are approved for monotherapy as well as for combinational regimes. ACE inhibitors are the dtugs of choice for the treatment of hypertension with renal diseases, particularly diabetic nephropathy, because they prevent the progression of renal failure and improve proteinuria more efficiently than the other diugs. 

Prevention of diabetic complications such as retinopathy, nephropathy, cardiomiopathy. 

Minimizing the quantity of contrast media administered may be beneficial in preventing nephropathy. Some studies, but not all, have directly associated dose of contrast media and nephrotoxicity. Avoidance of contrast dye with alternative diagnostic procedures should be considered in high-risk patients, but may not always be feasible. In addition, avoidance of multiple contrast studies in a short time period will allow renal function to return to normal between procedures. 

Mueller C, Buerkle G, Buettner HJ, et al. Prevention of contrast media-associated nephropathy randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 2002 162 329-336. 

Based on associations between abnormal serum J32m, -globulin and urinary albumin values and the number of times the PbB was above critical values, Chia et al. (1995a) suggested that the threshold of 70 pg/dL for PbB may not prevent the occurrence of nephropathy. 

It has already been noted above that hyperglycemia may affect nitric oxide production in different ways. Mohan and Das [129] demonstrated that NO prevented (3-cell damage in the model of alloxan-induced diabetes in rats. However, far more important data on the role of nitric oxide in diabetes development were obtained in the study of diabetic patients. Thus, Kedziora-Kornatowska [130] showed that there is difference in superoxide and NO production by the granulocytes from NIDDM patients NO production was increased in diabetic patients with and without diabetic nephropathy, while superoxide production was increased or decreased in the same patients, respectively. 

Acute uric acid nephropathy, which is characterized by the acute overproduction of uric acid and by extreme hyperuricemia, can best be prevented with which of the following ... 

Glucose and blood pressure control are most important for prevention of nephropathy, and blood pressure control is most important for retarding the progression of established nephropathy. 

In chronic studies, DMMP was administered by gavage in corn oil for up to 2 years at doses of 500 or 1000 mg/kg/day to rats and at doses of 1000 or 2000mg/kg/day to mice. " Survival in dosed male rats was reduced, due in part to renal toxicity. Lesions of the kidney included increased severity of spontaneous age-related nephropathy including calcification, hyperplasia of the tubular and transitional epithelium, tubular cell adenocarcinomas, and transitional cell papillomas and carcinomas. Similar lesions were not seen in female rats or in mice of either sex, although reduced survival in male mice prevented adequate analysis. The... 

Prevention of potassium depletion when dietary intake is inadequate in the following conditions Patients receiving digitalis and diuretics for CHF significant cardiac arrhythmias hepatic cirrhosis with ascites states of aldosterone excess with normal renal function potassium-losing nephropathy certain diarrheal states. 

Prevention of uric acid nephropathy during vigorous therapy of neoplastic disease ... 

Older patients have predominantly Type 2 diabetes mellitus, which shares with Type 1 the risk for retinopathy, nephropathy and neuropathy, but carries a greater risk for macrovascular complications such as coronary artery disease, stroke and peripheral vascular disease. Many such patients have associated obesity, hypertension and hyperlipidemia, compounding the risk of cardiovascular disease. The goals of treatment of DM in the elderly are to decrease symptoms related to hyperglycaemia and to prevent long-term complications. Treatment of type 2 DM can improve prognosis. In the UKPDS trial, sulphonylureas, insulin, and metformin were all associated with a reduction in diabetes-related... 

Pharmaceutical therapy of acute arthritis of crystal-deposition disease is effective, in particular for gout and hyperuricemia. Treatment is directed towards termination of acute arthritis, prevention of recurring attacks and prophylaxis and reversal of complications of chronic gout. Such complications include tophi, urolithiasis, nephropathy and with hyperuricemia associated medical problems that can be prevented, inhibited, and sometimes reversed. 

Exercise is an essential yet neglected aspect of treatment for type 2 diabetes especially in its early stages where insulin resistance may predominate. Accumulation of at least 30 0 minutes of moderate physical activity on most days of the week is recommended. For type 1 diabetes the emphasis must be on adjusting the therapeutic regimen to allow safe sports participation to prevent precipitation of ketoacidosis or hypoglycaemia. Extra care is required in cases with known complications like proliferative retinopathy, nephropathy, foot ulcers and cardiac or peripheral vascular disease. 

H. Makino, I. Tanaka, M. Mukoyama, A. Sugawara, K. Mori, S. Muro, T. Suganami, K. Yahata, R. Ishibashi, S. Ohuchida, T. Maruyama, S. Narumiya, K. Nakao, Prevention of diabetic nephropathy in rats by prostaglandin E receptor EPI-selective antagonist, J. Am. Soc. Nephrol. 13 (2002) 1757. 

To prevent uric acid nephropathy during chemotherapy PO Initially, 600-800 mg/day starting 2-3 days before initiation of chemotherapy or radiation therapy. IV 200-400 mg/mVday beginning 24-48 hr before initiation of chemotherapy. Akrt Maintenance dosage is laased on serum uric acid levels. Discontinue following the period of tumor... 

Unlabeled Uses Diabetic nephropathy, hypertension due to scleroderma renal crisis, hypertensive crisis, idiopathic edema, renal artery stenosis, rheumatoid arthritis, post Ml for prevention of ventricular failure... 

Iodinated radiographic contrast media can cause acute renal insufficiency, perhaps as a result of reduced renal blood flow, an intrarenal osmotic effect, or direct tubular toxicity (58). Diuretics, calcium channel blockers, adenosine receptor antagonists, acetylcysteine, low-dose dopamine, the dopamine Di receptor agonist fenoldopam, endothelin receptor antagonists, and captopril have all been used to prevent contrast nephropathy. 

Gross JL, de Azevedo MJ, Silveiro SP, et al. Diabetic nephropathy diagnosis, prevention, and treatment. Diabetes Care. 2005 28 164-176. 

Stegall MD, Larson TS, Kudva YC, et al. Pancreas transplantation for the prevention of diabetic nephropathy. Mayo Clin Proc. 2000 75 49-56. 

Contrast-induced nephropathy has been defined as an increase in serum creatinine of at least 25% or an absolute increase in serum creatinine of at least 0.5 mg/dL within 48 to 72 hours of iodinated contrast administration and is associated with significant morbidity and mortality (75). Important risk factors include diabetes mellitus, chronic renal insufficiency, administration of large volumes of high osmolar contrast agents, and intravascular volume depletion. Numerous pharmacologic preventive measures have been studied, but consistent benefits have not been demonstrated. In a recent large retrospective study, preprocedural statin therapy was independently associated with a lower risk of contrast nephropathy and nephropathy requiring dialysis (76). 

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