Renal disease, treatment

Bennett WM, Craven R. Urinary tract infections in patients with severe renal disease.Treatment with ampicillin and trimethoprim-sulfamethoxazole. Jama. 1976 Aug 23 236(8) 946-8. 

Farnesyl pyrophosphate (Fig. 30.2) is an intermediate in the biosynthesis of cholesterol, ubiquinone, and dolichol phosphates. Based on their site of action, HMGRis will decrease the availability of all four of these compounds and, thus, decrease cell proliferation. Potential applications of this antiproliferative effect include the prevention of restenosis following angioplasty, prevention of glomerular injury in renal disease, treatment of malignant disease, and prevention of organ transplantation rejection (40). 

ACE-I and ARB and Blood Pressure Lowering, Including Effect on Renal Disease. Treatment of Advanced Diabetic Renal Disease... 

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. 

A class of allosteric activators of the Ca2+-sensing receptor that sensitizes the receptor to extracellular calcium and acts only in the presence but not in the absence of calcium. Calcimimetics can be used to treat various forms of hyperparathyroidism, although they are only approved for use in patients with end stage renal disease receiving dialysis treatment. 

Erythropoietin (Eprex ) is physiologically produced in the kidney and regulates proliferation of committed progenitors of red blood cells. It is used to substitute erythropoietin in severe anemias due to end stage renal disease or treatment of cancer with cytostatic agents. Side effects include hypertension and increased risk of thrombosis. 

The anemias discussed in this chapter include iron deficiency anemia, anemia in patients witii chronic renal disease pernicious anemia, and anemia resulting from a folic acid deficiency. Table 45-1 defines these anemias. Drugp used in treatment of anemia are summarized in die Summary Drug Table Drugp Used in die Treatment of Anemia. 

Loop diuretics are used in the treatment of edema associated with CHF, cirrhosis of the liver, and renal disease, including the nephrotic syndrome. These drug s are particularly useful when a greater diuretic effect is desired. Furosemide is the drug of choice when a rapid diuresis is needed or if the patient has renal insufficiency. Furosemide and torsemide are also used to treat hypertension. Ethacrynic acid is also used for the short-term management of ascites caused by a malignancy, idiopathic edema, or lymphedema. 

This electrolyte plays a vital role in the acid-base balance of the body. Bicarbonate may be given IV as sodium bicarbonate (NaHC03) in the treatment of metabolic acidosis, a state of imbalance that may be seen in diseases or situations such as severe shock, diabetic acidosis, severe diarrhea, extracorporeal circulation of blood, severe renal disease, and cardiac arrest. Oral sodium bicarbonate is used as a gastric and urinary alkalinizer. It may be used as a single drug or may be found as one of the ingredients in some antacid preparations. It is also useful in treating severe diarrhea accompanied by bicarbonate loss. 

National and international trends over the past 15 years depict modest improvements in the treatment and/or control of blood pressure (BP) for hypertensive patients. This observation is made despite efforts to promote awareness, treatment, and the means available to aggressively manage high blood pressure. Over 65 million Americans have hypertension, which was listed as the primary cause of death for over 261,000 individuals in the United States in 2002.1 Hypertension is also a significant cause of end-stage renal disease and heart failure. National and international organizations continually refine their recommendations of how... 

There is growing evidence of a link between renal disease and HF.8 Renal insufficiency is present in one-third of HF patients and is associated with a worse prognosis. In hospitalized HF patients, the presence of renal insufficiency is associated with longer lengths of stay, increased in-hospital morbidity and mortality, and detrimental neurohormonal alterations. Conversely, renal dysfunction is a common complication of HF or results from its treatment. Renal failure is also a common cause for HF decompensation. 

Once the loading dose of the AED is administered, it is important to remember to initiate maintenance doses to ensure that therapeutic levels are sustained. Chronic and idiosyncratic side effects as well as potential drug interactions should be considered if the patient will continue AED therapy indefinitely. All drug therapy should be adjusted for any hepatic or renal disease states. Table 28-1 summarizes the drug doses used in SE, and Table 28-2 provides an example of an algorithm for the treatment of patients in SE. Published studies comparing these treatment strategies are summarized in Table 28-3. 

Thiazide diuretics such as chlorothiazide act on the distal tubule, a portion of the tubule that is permeable to sodium. The mechanism of action of these diuretics involves inhibition of NaCl reabsorption by blocking the Na+, CL symporter in the luminal membrane. The thiazide diuretics are only moderately effective due to the location of their site of action. Approximately 90% of the filtered Na+ ions have already been reabsorbed when the filtrate reaches the distal tubule. These drugs may be used for treatment of edema associated with heart, liver, and renal disease. Thiazide diuretics are also widely used for the treatment of hypertension. 

The pathophysiology, clinical manifestations, diagnosis, and treatment of acute renal failure and chronic kidney disease (CKD) or end-stage renal disease are discussed in Chaps. 75 and 76, respectively. 

Medea indications Persons with end-stage renal disease, including patients receiving hemodialysis persons seeking evaluation or treatment for a sexually transmitted disease (STD) persons with HIV infection and persons with chronic liver disease. 

Among the disadvantages of the LMWP strategy for the treatment of chronic renal disease are the requirement for parenteral administration and the possible immunogenicity of the... 

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... 

---