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Skip to 0 minutes and 11 seconds And for intrinsic ARF that’s actually has a lots of disease with damage renal cells in their renal. So for those patients you have to figure out their fundamental renal diseases. So for us for example, if a patient with allergic type interstitial nephritis the means of patient actually has high eosinophilia or has increased IgE and that could actually happen with a patient with a penicillin allergy or sulfonamides or NSAID. And treatment of glucocorticosteroids such as prednisone 10mg po QD for a week may help the patient to recover. And for some patient with other renal hypertensive nephrosclerosis or some vascular disease in renal control blood pressure without decrease renal blood flow is a goal.

Skip to 1 minute and 28 seconds And so those medications such as calcium channel blocker will be helpful before patient actually encounter a hypertensive crisis. So IV labetalol or sodium nitroprusside are important. And let’s look at post-renal azotemia treatment. And because this group of a patient actually has obstruction in their bladder or in their ureter. So some catheter will be helpful and remove for those obstruction or calculus will be top of treatment list. And for patient with some salt-wasting syndrome half-saline will be useful.

Skip to 2 minutes and 24 seconds So after those treatments if we treat patients not quickly enough or the patient actually develop a very severe ARF. That will starting to have a lots of complications. So metabolic acidosis or electrolyte imbalance such as hyperkalemia, hypermagnesium, hyperphosphatemia, hypocalcemia well actually develop. So each of their electrolyte imbalance we have to use their specific treatments such as with hyperkalemia insulin or dose treatment to remove our calcium are important. And for hyperphosphatemia phosphatase binder will be important. And some of the patient actually with prolonged ARF. Their original reason to develop ARF is actually cardiovascular reasons so treating those underlie disease are also important. And for later on the patient may actually develop arrhythmia or hypertension and treatment for less or directly.

Skip to 3 minutes and 58 seconds And those patient with ARF they may actually develop some neuromuscular complications so specific treatment for a seizure those are also important. And hematology Usually, anemia will not occur during ARF. And anemia is a very important issue and CRF in chronic renal failure, and we will actually detail the treatment, in my next week lecture for CRF. But as very seldom to see a patient in ARF develop anemia And many patients may have actually GI symptoms such as nausea vomiting. Sometimes we still need to have some symptom treatment. And infection And infection is very important especially UTI will actually make their patients ARF become much worsen. So antibiotics selection is very important.

Specific therapy & Complications of ARF

In this step, Prof. Chen demonstrates the specific therapy for intrinsic ARF and post-renal azotemia, then explains complications of ARF.

To begin with, for intrinsic ARF, we can use gluco-corticosteroids to treat those with allergic interstitial nephritis, and use clonidine, prazosin or CCB to treat those with malignant hypertensive nephrosclerosis.

For post-renal azotemia, we can remove calculus or other obstruction. If the patient has salt-wasting syndrome, we can use 0.45% saline to improve the situation.

Finally, there are plenty of complications of ARF, including metabolic, cardiovascular, neuromuscular, hematologic, gastrointestinal syndrome, and infection.

Infection is very important which makes ARF worse. Therefore, antibiotics selection is also important when dealing with ARF.

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This video is from the free online course:

Pharmacokinetics: Drug Dosing in Renal Disease

Taipei Medical University