Understanding Chronic Kidney Disease by Lewis Robert;

Author:Lewis, Robert;
Language: eng
Format: epub
Publisher: M&K Update Ltd

Other causes of pre-renal insult

Systemic infection: People with CKD often show a transient decline in renal function during an intercurrent infection. This is partly because of loss of fluid as sweat, but it is also due to the effects of inflammatory mediators on renal perfusion and function. As is the case in dehydration, it is wise to suspend those drugs that affect renal compensatory mechanisms (see above). There should also be an attempt to identify the source of infection. Bacteriological analysis of the urine is advised, as urinary tract infection may not be clinically overt, especially in the elderly. Referral for advice is necessary if the change in renal function is marked, as in-patient rehydration and treatment of sepsis may be required.

Congestive cardiac failure: The combination of CKD and congestive cardiac failure (CCF) carries a poor prognosis and is very difficult to treat. Not only is renal perfusion reduced, threatening the adequacy of GFR, but the drugs used to treat CCF often have adverse renal effects. This is particularly true of diuretics, where a balance must be struck between pulmonary oedema on the one hand and diuretic-induced salt/water depletion on the other. There is no alternative but to monitor symptoms and renal function regularly, reducing the dose of diuretics if renal function deteriorates and increasing the dose if the patient reports worsening dyspnoea. The management of CCF in the context of CKD is covered in depth in Chapter 13.

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