Acute tubular necrosis medical therapy: Difference between revisions

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==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
According to the Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines, management approach of acute tubular necrosis include examination of all [[Patient|patients]] thoroughly to identify the [[Causes|cause]], precipitating factors, and [[Comorbidity|comorbid conditions]] leading to a rapid reduction in [[Glomerular filtration rate|GFR]], which may be reversible and regular monitor patients for serum creatinine, BUN, and urine output to assess the severity of [[Kidney|renal]] damage.
 
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.
 
OR
 
[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].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
* Acute tubular necrosis, which is usually reversible. It may be associated with high [[morbidity]] and [[Mortality rate|mortality]]. Early recognition and management are essential for a better outcome.<ref name="pmid2195259">{{cite journal |vauthors=Finn WF |title=Diagnosis and management of acute tubular necrosis |journal=Med. Clin. North Am. |volume=74 |issue=4 |pages=873–91 |date=July 1990 |pmid=2195259 |doi= |url=}}</ref>
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
* According to the Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines, management approach of acute tubular necrosis include,
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
** Examine all [[Patient|patients]] thoroughly to identify the [[Causes|cause]], precipitating factors, and [[Comorbidity|comorbid conditions]] leading to a rapid reduction in [[Glomerular filtration rate|GFR]], which may be reversible.
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
** Regularly monitor patients for serum creatinine, BUN, and urine output to assess the severity of [[Kidney|renal]] damage.
===Disease Name===
** Assess volume status and manage it accordingly.
 
*** [[Hypovolemia]]: Proper hydration or isotonic saline administration can be helpful in treating [[Hypovolemia|volume depletion]].
* '''1 Stage 1 - Name of stage'''
*** [[Hypervolemia]]: The only indication of using diuretics in [[Acute kidney injury|acute renal failure]] to manage volume overload status.
** 1.1 '''Specific Organ system involved 1'''
** Avoiding or minimizing the dosage of nephrotoxic medications, and radiocontrast media.
*** 1.1.1 '''Adult'''
** According to KDIGO guidelines, following medications have no role in the management and outcome of acute tubular necrosis:<ref name="pmid11505120">{{cite journal |vauthors=Kellum JA, M Decker J |title=Use of dopamine in acute renal failure: a meta-analysis |journal=Crit. Care Med. |volume=29 |issue=8 |pages=1526–31 |date=August 2001 |pmid=11505120 |doi= |url=}}</ref><ref name="pmid17352669">{{cite journal |vauthors=Bagshaw SM, Delaney A, Haase M, Ghali WA, Bellomo R |title=Loop diuretics in the management of acute renal failure: a systematic review and meta-analysis |journal=Crit Care Resusc |volume=9 |issue=1 |pages=60–8 |date=March 2007 |pmid=17352669 |doi= |url=}}</ref>
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
*** [[Diuretic|Diuretics]], except to treat hypervolemia
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
*** [[Atrial natriuretic peptide]]
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
*** [[Dopamine]]
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
*** [[Fenoldopam]]
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
** Appropriate management of electrolyte and acid-base imbalance:
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** [[Hyperkalemia]]: [[Hyperkalemia]] is a life-threatening complication associated with acute tubular necrosis. 
*** 1.1.2 '''Pediatric'''
**** 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 [[Na+/K+-ATPase|sodium-potassium ATPase]].
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
**** 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 (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
**** Preferred regimen (3): [[Dialysis]] in severe and refractory cases.
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
*** [[Metabolic acidosis]]:
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
**** Preferred regimen: [[Sodium bicarbonate]] can be given to treat [[metabolic acidosis]].  
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
** Renal replacement therapy:
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
*** Indications for renal replacement therapy include:
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
**** Severe hyperkalemia
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h(maximum, 100 mg per dose)
**** Hypervolemia
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
**** Uremia
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)  
**** Severe metabolic alkalosis
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
 
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 02:15, 12 August 2018

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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

According to the Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines, management approach of acute tubular necrosis include examination of all patients thoroughly to identify the cause, precipitating factors, and comorbid conditions leading to a rapid reduction in GFR, which may be reversible and regular monitor patients for serum creatinine, BUN, and urine output to assess the severity of renal damage.

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.
    • 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]
    • Appropriate management of electrolyte and acid-base imbalance:
    • Renal replacement therapy:
      • Indications for renal replacement therapy include:
        • Severe hyperkalemia
        • Hypervolemia
        • Uremia
        • Severe metabolic alkalosis

References

  1. Finn WF (July 1990). "Diagnosis and management of acute tubular necrosis". Med. Clin. North Am. 74 (4): 873–91. PMID 2195259.
  2. 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.
  3. 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.

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