TRC: Treatment of CKD

Treatment of chronic kidney disease

Treatment of chronic kidney disease (CKD)

CKD has to be treated according to the clinical action plan. Treatment of the original diseases that cause CKD is often not possible or effective. However, pharmacological and non-pharmacological treatments help to slow the decline in renal function and to minimize complications. Hypertension and proteinuria are the most important progression factors, which can be controlled with ACE inhibitors, AT-II receptor antagonists and/or spironolactone, in combination with salt restriction and diuretics (hydrochlorothiazide or furosemide). Other renoprotective measures are restriction of animal protein, calories in obesity and cigarettes.

Recombinant erythropoietin or darbepoietin in combination with iron supplements and vitamin C may be needed to control anemia.

Vitamin D deficiency should be treated with cholecalciferol in mild to moderate CKD and alfacalcidol in severe CKD.

Hyperphosphatemia should be prevented by dietary phosphate restriction and phosphate binders calcium carbonate or calcium acetate. Vitamin D and phosphate management is necessary to control secondary hyperparathyroidism.

Metabolic acidosis can be treated with sodium bicarbonate in addition to dietary protein restriction.

Decreased potassium intake, resonium and diuretics will help to prevent hyperkalemia.

Dialysis is needed once GFR is lower than 10 ml/min together with signs of the uremic syndrome: anorexia, nausea, fatigue, pruritis, neuropathy or pericarditis.

Which management of chronic renal failure is WRONG?

Extra info: Those with tubulo-interstitial diseases, renal cystic disease, obstructive uropathy and reflux nephropathy have what is called salt loosing nephropathy, hence water and salt loss may be profound and may further deteriorate the picture, so these should be replaced carefully.

Option explanation:

hypertriglyceridemia is common and hypercholesteremia is almost universal in those who have significant proteinuria

ACE inhibitors for hypertension have significantly been shown to retard the disease progression especially in diabetics

replacing sodium and chloride with high fluid intake should be avoided in all patients

hypocalcemia is very common and should be corrected by vitamin D metabolites

Treatment of chronic kidney disease

Treatment of chronic kidney disease (CKD)

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