Renal failure, prophylaxis

The primary goals of management of tumor lysis syndrome are (1) prevention of renal failure and (2) prevention of electrolyte imbalances. Thus the best treatment for tumor lysis syndrome is prophylaxis to enable delivery of cytotoxic therapy for the underlying malignancy. 

The primary goals of management of tumor lysis syndrome are (1) prevention of renal failure and (2) prevention of electrolyte imbalances. Thus the best treatment for tumor lysis syndrome is prophylaxis to enable delivery of cytotoxic therapy for the underlying malignancy. For patients who present with or develop tumor lysis syndrome despite prophylaxis, treatment goals include (1) decrease uric acid levels, (2) correct electrolyte imbalances, and (3) prevent compromised renal function. These goals should be achieved in a cost-effective manner. 

Prophylaxis of renal failure. In circulatory failure (shock), e.g., secondary to massive hemorrhage, renal production of urine may cease (anuria). By means of diuretics an attempt is made to maintain urinary flow. Use of either osmotic or loop diuretics is indicated. 

Pharmacokinetics Slow intravenous infusion is employed for treatment of systemic infections or for prophylaxis. Because vancomycin is not absorbed after oral administration, this route is only employed for the treatment of antibiotic-induced colitis due to Q difficile. Inflammation allows penetration into the meninges. Metabolism is minimal 90-100 % is excreted by glomerular filtration. [Note Dosage must be adjusted in renal failure since the drug will accumulate. Normal half-life is 6-10 hours compared to over 200 hours in end-stage renal disease.]... 

Vos SC, Hage JJ, Woerdeman LA, Noordanus RP. Acute renal failure during dextran-40 antithrombotic prophylaxis report of two microsurgical cases. Ann Piast Surg 2002 48(2) 193-6. 

Flomsi E, Barreiro MF, Orlando JM, and Fliga EM. 1997. Prophylaxis of acute renal failure in patients with rhabdomyolysis. Ren Fo 7... 

Better OS. Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis. N Engl J Med 1990 322 825-828. 

The observation of a differing incidence of acute renal failure in patients undergoing coronary artery bypass surgery in two similar units, prompted a retrospective review of patient records. This showed that the only management differences were related to antibacterial prophylaxis and the bypass prime content (i.e. the solution used to prime the cardiopulmonary bypass circuit). 

Hewlett DC, Greenwood KL, Jarosz JM et al (1997) The incidence of transient medullary hyperechogenicity in neonatal ultrasound examination. Br J Radiol 70 140-143 Huber W, Eckel F, Henning M et al (2006) Prophylaxis of contrast material-induced nephropathy in patients in intensive care acetylcysteine, theophylline, or both A randomized study. Radiology 239 793-804 Huet F, Semama D, Grimaldi M et al (1995) Effects of theophylline on renal insufficiency in neonates with respiratory distress syndrome. Intensive Care Med 21 511-514 Kaplan BS, Restaino I, Raval DS et al (1994) Renal failure in the neonate associated with in utero exposure to nonsteroidal anti-inflammatory agents. Pediatr Nephrol 8 700-704... 

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