KIDNEY-DISORDERS.pdf

CLINICAL PHARMACY

________ are usually caused by chronic urinary tract infections.

________ are usually caused by chronic urinary tract infections.

Struvite stones

________: an acute or chronic kidney disease that occurs when the kidneys are unable to properly remove waste and excess fluids from the body.

Glomerulonephritis Definition

Signs and symptoms: loss of appetite, a general feeling of illness (malaise), ________ and tissue swelling, abdominal pain, wasting of muscles (atrophy), frothy urine, swollen abdomen, shortness of breath, swelling of the knees and, in men, the scrotum, shock.

puffy eyelids

Supplemental alkali

________, 1- 3 mmol /kg of body weight per day, should be given in three or four evenly spaced, divided doses, one of which should be given at bedtime.

________ is an oral quinazoline diuretic for the management of edema and hypertension.

Metolazone

Discontinuation of the offending agents such as NSAID End- stage renal disease (________) End- stage kidney disease is a complete or near complete failure of the kidneys to function to excrete wastes, concentrate urine, and regulate electrolytes.

ESRD

________ are often used to reduce kidney inflammation.

Corticosteroids

Pain usually begins in the lower back and moves to the abdomen, groin, or ________ as the stone moves from the kidney toward the bladder.

genital areas

________: A term used to describe toxic damage in the kidneys; electrolytes in the blood, including potassium and magnesium, build up to toxic levels.

Nephrotoxicity Definition

(also called renal calculi, urinary calculi, urolithiasis, or nephrolithiasis) usually develop when the urine becomes too concentrated.

Kidney stones

(kidney dialysis) is usually done for kidney failure.

Hemodialysis

Mannitol, glucose) are filtered in the ________, but can not be reabsorbed.

glomerulus

To maintain ________, water is retained in the urine.

osmotic balance

It can occur by itself or in conjunction with other diseases such as lupus, goodpasture syndrome, diabetes, immunoglobulin A (IgA) nephropathy, polyarteritis, Wegener granulomatosis, or infection with streptococcus, HIV, hepatitis B or C Signs and symptoms: dark- colored urine, foamy urine, high blood pressure, fluid retention that causes swelling, fatigue, and less- frequent urination Treatment a) The goal of treatment is to reduce the decline of kidney function and control blood pressure.

reduce the decline of kidney function and control blood pressure.

Cockcroft Gault

________ equation or the Modification of Diet in Renal Disease (MDRD) study equations may be used for routine estimation of GFR.

________ such as hydrochlorothiazide act on the distal tubule and inhibit the sodium- chloride symporter leading to retention of water in the urine as water normally follows penetrating solutes.

Thiazides

Solutes, both small and large, get dragged through the membrane at a similar rate by the ________ that has been engineered by the hydrostatic pressure.

flow of water

As in dialysis, in hemofiltration one achieves ________ across a semipermeable membrane.

movement of solutes

C) Antihypertensives (________, ARB): reduces the amount of protein in the urine by reducing the amount of pressure and resistance on blood as it circulates through the body.

ACE inhibitors

________ is not a true thiazide, but it is a sulfonamide derivative such as thiazides, and its site of action is similar.

Metolazone

The tubes in the kidneys do not work properly

Fanconi syndrome Definition

an acute or chronic kidney disease that occurs when the kidneys are unable to properly remove waste and excess fluids from the body

Glomerulonephritis Definition

It can occur by itself or in conjunction with other diseases such as lupus, Goodpasture syndrome, diabetes, immunoglobulin A (IgA) nephropathy, polyarteritis, Wegener granulomatosis, or infection with streptococcus, HIV, hepatitis B or C Signs and symptoms

dark-colored urine, foamy urine, high blood pressure, fluid retention that causes swelling, fatigue, and less-frequent urination Treatment a) The goal of treatment is to reduce the decline of kidney function and control blood pressure

Focal segmental glomerulosclerosis (FSGS) Definition

A type of glomerular disease that can cause permanent kidney disease in children and adults by attacking the glomeruli, the tiny structures inside the kidneys where blood is filtered

Other symptoms include blood in the urine, cloudy or foul-smelling urine, nausea, vomiting, and constant urge to urinate Treatment a) Calcium stones

Thiazide diuretics lower urine calcium in idiopathic hypercalciuria and are effective in preventing the formation of stones

b) Uric acid stones

The two goals of treatment are to raise urine pH and to lower excessive urine uric acid excretion to less than 1 g per day

c) Cystine stones

high fluid intake, even at night

Daily urine volume should exceed 3 L. Raising urine pH with alkali is helpful, provided the urine pH exceeds 7.5. d) Struvite stones

Complete removal of the stone and subsequent sterilization of the urinary tract is the treatment of choice for patients who can tolerate the procedures

Nephrotoxicity Definition

A term used to describe toxic damage in the kidneys; electrolytes in the blood, including potassium and magnesium, build up to toxic levels

c) Stage 3 (overt, or dipstick-positive diabetes)

Glomerular damage has progressed to clinical albuminuria

Glomerular damage continues, with increasing amounts of protein albumin in the urine

d) Stage 4 (late-stage diabetes)

GFR has fallen to approximately10 mL/min, and renal replacement therapy (i.e., hemodialysis, peritoneal dialysis, kidney transplantation) is needed

e) Stage 5 (end-stage renal disease [ESRD])

Drugs that may cause glomerular disease include NSAID, recombinant interferon A, rifampin, penicillin, ampicillin, amoxicillin, gold, penicillamine, trimethadione, captopril, chlormethiazole, ciprofloxacin, hydralazine, allopurinol, sulfonamides, thiazides, warfarin, carbimazole, heroin, and amphetamines Acute renal failure (ARF)

a syndrome characterized by rapid decline in glomerular filtration rate (hours to days), retention of nitrogenous waste products, and perturbation of extracellular fluid volume and electrolyte and and hydration can be used to treat ARF

Exogenous administration of albumin increases the oncotic pressure of the intravascular system, pulling fluids from the interstitial space, thereby decreasing edema and increasing the circulating blood volume

b) Albumin

reduces the amount of protein in the urine by reducing the amount of pressure and resistance on blood as it circulates through the body

c) Antihypertensives (ACE inhibitors, ARB)

Dosages of renally excreted drugs may need to be adjusted according to kidney function

Dosing Adjustments

hemodialysis and peritoneal dialysis

than in normal blood, to encourage diffusion of bicarbonate into the blood, There are two primary types of dialysis

a short-term treatment, used in patients with kidney failure

Continuous veno-venous hemofiltration (CVVH)