Renal Treatment Flashcards
Hyperkalemia treatment
1st: Calcium gluconate (stabilises cardiac membrane)
Then
-Insulin 50mls 50% dextrose 30 m (puts potassium back into ICS from ECS)
-Saba neb (90 min) (not necessary)
- sodium bicarbonate for acidotic patients
when do you use dialysis
Severe acidosis ph<7.15
hyperkalaemia, persistently >7
pericardial rub/encephalopathy cause by uraemia
pulmonary oedema + oliguria
Uraemia: >40
what is CMV transplant patient treatment
kidney transplant-
prophylaxis po valangoclovir (unless both donor & recipient are CMV neg)
IV gangiclovir if evidence of CMV infection
IgA nephropathy <500-1000 mg/day proteinuria
and normal GFR treatment
no treatment. follow up to check renal function
IgA nephropathy >1g/day proteinuria and normal/slightly inc GFR
treatment
this describes moderate IgA nephropathy:
initial treatment with ace
failure to respond: immunsupression with corticosteroids
Myeloma treatment
include the tx for renal failure caused by myeloma
Chemotherapy, stem cell transplant
For renal failure- dialysis (supportive)
minimal change disease mainstay of treatment
(2 lines)
oral corticosreroids
2nd: cyclophosphamide is the next step for steroid resistent cases
CKD mineral bone disease treatment
aim of treatment is to reduce phosphate and pth
1st line: low phosphate diet
primary membranous nephropathy tx
all patients should recieve an ACE inhibitor/ARB
severe/progressive disease: corticosteroid + cyclophosphamide
treatment for peritonitis
vancomycin + ceftazidime added to dialysis fluid
or
vancomycin added to dialysis fluid + ciprofloxacin by mouth
GPA treatment
initial: give methylprednisolone to halt disease and
definitive: cyclophosphamide (this takes a short while to kick in hence the steroids) and plasma exchange
GPA treatment in old/immunocrompimised
ritiximab and plasma exchange
focal segmental glomerulonephritis treatment
oral steroids
2nd: ciclosporin/cyclophosphamides
Most important management for urinary incontinence
1st line:
Lifestyle modification- weight loss, stop smoking, avoid constipation, modify fluids intake, stop drinking caffeine
1st line pharmacological treatment for urinary incontinence
Oxybutynin- (anti-mucarininc receptor)
acute retention tx
urological emergency:
catheter and alpha blocker!
acute renal colic Tx for small stone
diclofenac IM/ PR + opiate
give alpha blocker for small stones that are expected to pass
do CT scan 3 weeks later
torsion of testes tx
surgical, unwind tests have to do surgery on both tests as inc chance of other test being affected
(just reminder u get a blue dot on torsion of testes)
epidydmitis treatment
analgesia + scrotal support+ bed rest
ofloxacin 400mg/day for 14 days
paraphimosis tx
under penile block, manual compression of glans with distal traction on oedematous skin
might have to dorsal slit
fourniers gangrene tx
antibiotic and surgeical debridement
renal cell carcinoma treatment for T1a (3-4cm)
elderly and unfit: surveillance
elderly and fit: ablation
some younger patients also receive ablation
partial nephrectomy
renal cell carcinoma tx for >3-4cm
elderly and unfit: surveillance
elderly and fit: ablation
some younger patients also receive ablation
young:
partial nephrectomy
radical nephrectomy
(same as small tumour tx except radical nephrectomy also used)
gold standard treatment for larger renal cell carcinoma tumours (>7cm)
laproscopic radical nephrectomy
HSP treatment
analgesia and supportive treatment for nephropathy.
after discharge patients have to monitor bp and urine dipstick at home and then followed up 7 days post discharge.
if there is any proteinuria then patients will have check ups every 3 months
when to treat hyperkalemia/ initial management
if >6.5mmol then straight away treat (calcium gluconate etc.)
if <6.5 but above normal then carry out ECG first. l
scleroderma renal crisis treatment
1st line is ace
tx for AL amyloidosis
immunosupression- steroids, chemo, stem cell transplant
tx for AA amyloidosis
treat underlying cause
post streptococcal glomerulonephritis tx
supportive, monitor fluid balance
good prognosis
Anti-GBM/goodpastures tx
IV prednisolone, cyclophosphamide and plasmapheresis
Microscopic polyangitis tx
plasmapheresis acutely to remove P-anca
long term presdnisolone and cyclophosphamide
what should all patients with chronic kidney disease be prescribed
statin, to prevent CVD
hypertensive chronic kidney disease management
statins for all
1st ace
2nd: + furosemide
churg strauss mx
high dose corticosteroids then taper down (over months/years)
at what cut off value should diabetics with CKD start on an ACE
albumin ratio of >2.5mg in men or >3.5 mg in women
SLE renal flare tx
treat the hypertension
1st line: cyclophosphamide + corticosteroids
2nd: mycophenylate + corticosteroid
pain relief for renal stones
diclofenac IM/PR
Haemolytic uraemic syndrome treatment
1st: supportive: fluids, dialysis and bloods if required
plasma exchange for v complicated cases and cases not associated with diarreah
or
eculizumab
when to stop giving a newly prescribed ACE inhibitor
if after two weeks creatinine has risen by 30% or more from baseline then stop ACE!
