The purpose of CRF drug treatment include: ① Relieve symptoms of CRF, reduce or eliminate the patient's suffering, improve quality of life. ② Delay progress of disease course of CRF to prevent its further spread. ③ Prevent complications and improve survival.
1. Correct acidosis and water, electrolyte imbalance
(1) Proper metabolic intoxication: Treatment of metabolic acidosis, especially oral sodium bicarbonate (NaHCO3) .Pacientes moderate and severe when necessary, intravenous infusion, 72 hours or more after the correction of the basic acidosis. for no obvious for patients with heart failure should prevent excessive amount of NaHCO3 input, the input speed should be slow, so as not to aggravate cardiac stress even aggravate heart failure.
(2) Prevention and treatment of disorders of water and sodium: suitable for sodium intake restrictions, NaCl general consumption should not exceed 6 ~ 8 g / d. Significant edema, patients with hypertension, sodium intake is usually 2 ~ 3 g / d (consumption of NaCl 5 ~ 7 g / d), severe cases may be limited to person 1 ~ 2 g / d (NaCl 2.5 ~ 5 g) .Also may be necessary to loop diuretics (furosemide, bumetanide, etc), thiazide diuretics and potassium-sparing diuretics for storage disease CRF (Scr> 220μmol / L) treatment is very poor, no should be applied. For patients with acute heart failure, severe pulmonary edema, the need for timely given simple ultrafiltration, continuous hemofiltration (as a continuous veno - venous hemofiltration).
For patients with mild to moderate chronic renal failure, hyponatremia generally have no active treatment, and should discuss their various reasons, only those genuine lack of sodium salt supplement carefully. Severe shortage of sodium hyponatremia, also staged in the state of hyponatremia gradually corrected.
(3) Prevention and treatment of hyperkalemia: Patients with renal failure prone to hyperkalemia, the serum potassium level> 5.5mmol / L particular, should be stricter limits the intake of potassium. Limit consumption of potassium should also pay attention to the timely correction of acidosis and appropriate application of diuretics (furosemide, bumetanide etc), increased urinary potassium excretion in order to effectively prevent the occurrence of hyperkalemia .
The existing hyperkalemia in patients, and limit your intake of potassium, should take the following steps: ① Actively correct acidosis, if necessary (serum potassium> 6 mmol / L) may be sodium bicarbonate intravenously. ② Given loop diuretics furosemide bumetanide injection or preferably intravenously or intramuscularly. ③ Application of glucose-insulin solution inlet. ④ Resin potassium Oral drop: more applicable to calcium polystyrene sulfonate, because the ion exchange process is only released from sodium calcium not release without increasing the sodium load. ⑤ For severe hyperkalemia (serum potassium> 6.5 mmol / L), accompanied by oliguria, diuretic is effective, it must give the hemodialysis system.
2. Treatment of hypertension
Hypertension timely and reasonable treatment, not only to control some of the symptoms of high blood pressure, but also to proactively protect the target organ (heart, kidney, brain etc) .Inhibidores-converting enzyme inhibitors (ACEI) agonists ⅱ receptor blockers (ARB) antagonists, calcium channel blockers, loop diuretics, β-blockers, vasodilators can be applied to ACEI, ARB, wider application of calcium antagonists. Blood pressure before predialysis CRF patients should be <130 / 80mmHg, blood pressure maintenance dialysis patient is usually not higher than 140 / 90mmHg.
3. Treatment of anemia and applications erythropoiesis stimulating agent (ESA)
When hemoglobin (Hb) <110 g / L or hematocrit (Hct) <33%, the cause of anemia should be checked. If iron deficiency should iron treatment, if necessary, can be applied to therapy of ESA, including recombinant human erythropoietin (rHuEPO), epoetin way to Hb increased to 110 ~ 120 g / L.
4. Treatment of hypocalcemia, hyperphosphatemia and renal osteodystrophy
When GFR <50ml / min after which the intake should be restricted appropriately phosphorus (<800 ~ 1000 mg / d) .When GFR <30ml / min, while limiting phosphorus intake, be applied oral phosphate binders to carbonate calcium, calcium citrate is better. To clear hyperphosphatemia (serum phosphorus> 7 mg / dl) or serum Ca, P product> 65 (mg 2 / dl2) who should suspend the application of calcium to prevent aggravation of metastatic calcification. Then you can consider taking aluminum hydroxide preparations short-term or sevelamer, which Ca, P product <65 (mg 2 / dl2), then take calcium.
For obvious patients oral hypocalcemia 1.25 (OH) 2D3 (calcitriol) .even portion 2 to 4 weeks, and if the blood calcium levels and no improvement of symptoms, increasing dose. Control therapy requires blood Ca, P, PTH levels, so predialysis blood PTH CRF patients maintained at 35 ~ 110pg / ml. make dialysis patients blood phosphorus product <55mg2 / dl2 (4.52mmol2 / L2), serum PTH remained at 150 ~ 300 pg / ml.
5. Prevention of infection
Usually must be taken to prevent colds, prevention of infection by pathogens. Antibiotic selection and application of the principles and infections generally the same, only the dose should be adjusted. For similar efficacy, should choose the least nephrotoxic drugs.
6. The treatment of hyperlipidemia
Before predialysis patients with CRF and the general principles of treatment of hyperlipidemia itself, should be actively treated. However, for maintenance dialysis patients, hyperlipidemia standards should be relaxed, and cholesterol levels in the blood are maintained at 250 ~ 300mg / dl, triglyceride levels in serum remain at 150 ~ 200mg / dl all right.
7. Therapy oral absorption and catharsis therapy
Therapy oral absorption (oxidized starch or oral formulations of activated carbon), catharsis therapy (oral formulations rhubarb) ect.Puede increase colon dialysis using parenteral discharged uremic toxins. The therapy is mainly used in patients with predialysis CRF prior to relieve the patient azotemia play a supporting role.
(1) Patients with diabetic renal insufficiency with decreased GFR, should be adjusted accordingly insulin dose, the general should be gradually reduced.
(2) Hyperuricemia: Generally do not need treatment, but gout, then allopurinol.
(3) Itching: emulsified oil topical, oral antihistamines to control hyperphosphatemia and strengthening high dialysis or dialysis cash flow for some patients.
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