Acute tubular necrosis medical therapy

Acute tubular necrosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Acute tubular necrosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Acute tubular necrosis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Acute tubular necrosis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Acute tubular necrosis medical therapy
CDC on Acute tubular necrosis medical therapy
Acute tubular necrosis medical therapy in the news
Blogs on Acute tubular necrosis medical therapy
Directions to Hospitals Treating Acute tubular necrosis
Risk calculators and risk factors for Acute tubular necrosis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]

Overview

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

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

• 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.
• 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 and urine output to assess the severity.
  • Assess volume status and manage it accordingly.
    • Hypovolemia: Proper hydration or isotonic saline administration can be helpful in treating volume depletion.
    • Hypervolemia: The only indication of using diuretics in acute renal failure to manage volume overload status.
  • 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:
    • Diuretics except to treat hypervolemia
    • Atrial natriuretic peptide
    • Dopamine
    • Fenoldopam
  • Appropriate management of electrolyte and acid-base imbalance:
    • Hyperkalemia: Hyperkalemia is a life-threatening complication associated with acute renal failure.
      • Preferred regimen (1): Insulin (eg, intravenous injection of 10-15u of short-acting insulin) along with 50ml of dextrose will lead to a shift of potassium ions into cells, secondary to increased activity of the sodium-potassium ATPase.
      • Preferred regimen (2): Calcium (eg, calcium gluconate, preferably through a central venous catheter as the calcium may cause phlebitis) does not lower potassium but decreases myocardial excitability, protecting against life-threatening arrhythmias.
      • Preferred regimen (3): Dialysis in severe and refractory cases.
    • Metabolic acidosis: Sodium bicarbonate can be given to treat metabolic acidosis.
  • Renal replacement therapy:
    • Indications for renal replacement therapy include:
      • Severe hyperkalemia
      • Hypervolemia
      • Uremia
      • Severe metabolic alkalosis