Azotemia Medication

  • Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FACP, FASN   more...
 
Updated: Dec 1, 2010
 

Medication Summary

The goals of therapy are to increase renal perfusion and to maintain urine output. Specific therapy for various systemic conditions affecting the kidney is discussed in other articles.[10]

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Diuretics

Class Summary

To induce urine output in ATN, treat edema and hypertension. These drugs increase urine excretion by inhibiting sodium and chloride reabsorption at different sites in the nephron.

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Furosemide (Lasix)

 

Drug of choice as a diuretic. Inhibits sodium chloride reabsorption in the thick ascending limb of the loop of Henle.

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Metolazone (Mykrox, Zaroxolyn)

 

Adjunct to furosemide in severe edematous states or when furosemide alone does not achieve adequate diuresis. Increases excretion of sodium, water, potassium, and hydrogen ions by inhibiting reabsorption of sodium in distal tubules. Metolazone may be more effective in impaired renal function.

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Adrenergic agents

Class Summary

These agents stimulate vasodilation of the renal vasculature and enhance perfusion.

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Dopamine (Intropin)

 

Above a critical dose (renal dose), this drug becomes a potent vasoconstrictor. Renal dose dopamine is used widely, but benefit has not been established clearly.

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Plasma volume expanders

Class Summary

Increase plasma oncotic pressure and mobilize fluid from the interstitial space into the intravascular space in hypoalbuminemic patients. Enhance delivery of furosemide to distal tubule.

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Albumin (Albuminar, Albumisol, Albunex, Albutein)

 

Supplied as a 5% solution in 250 mL or 25% in 50 mL. Preference is based on whether patient requires additional fluid replacement. Not used for nutritional supplementation; thus, attempts should be made to improve patient's nutrition.

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Corticosteroids

Class Summary

Potent anti-inflammatory agent and immunosuppressant. Suppresses humoral and cellular response to tissue injury, thereby reducing inflammation.

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Prednisone (Sterapred)

 

Used commonly for many forms of glomerulonephritis and interstitial nephritis

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Contributor Information and Disclosures
Author

Moro O Salifu, MD, MPH, FACP  Associate Professor, Department of Internal Medicine, Chief, Division of Nephrology, Director of Nephrology Fellowship Program and Transplant Nephrology, State University of New York Downstate Medical Center

Moro O Salifu, MD, MPH, FACP is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Artificial Internal Organs, American Society of Diagnostic and Interventional Nephrology, American Society of Nephrology, American Society of Transplantation, and National Kidney Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Onyekachi Ifudu, MD  Director of Inpatient Dialysis Services, Associate Professor, Department of Internal Medicine, State University of New York Health Science Center at Brooklyn

Disclosure: Nothing to disclose.

Specialty Editor Board

Frank C Brosius III, MD  Nephrology Program Director, Professor of Internal Medicine and Physiology, Department of Internal Medicine, Division of Nephrology, University of Michigan School of Medicine

Frank C Brosius III, MD is a member of the following medical societies: Alpha Omega Alpha, American Diabetes Association, American Society of Nephrology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

George R Aronoff, MD  Director, Professor, Departments of Internal Medicine and Pharmacology, Section of Nephrology, Kidney Disease Program, University of Louisville School of Medicine

George R Aronoff, MD is a member of the following medical societies: American Federation for Medical Research, American Society of Nephrology, Kentucky Medical Association, and National Kidney Foundation

Disclosure: Nothing to disclose.

Rebecca J Schmidt, DO, FACP, FASN  Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine

Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association

Disclosure: Abbott Grant/research funds Speaking and teaching; AMAG Honoraria Speaking and teaching; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching; Renal Ventures Ownership interest Other

Chief Editor

Vecihi Batuman, MD, FACP, FASN  Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology

Disclosure: Nothing to disclose.

References

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The graph shows the relationship of the glomerular filtration rate (GFR) to steady-state serum creatinine and blood urea nitrogen (BUN) levels. As shown in this figure, in early renal disease, substantial decline in GFR may lead to only a slight elevation in serum creatinine. Elevation in serum creatinine is apparent only when the GFR falls to about 70 mL/min.
Diagnostic Images in Azotemia: Although these indices are helpful, it is not necessary to perform all these tests on a particular patient. Comparison should always be made with the patients baseline values to identify trends consistent with increase or decrease in effective circulating volume. It should be noted that use of some of these indices may be limited in certain clinical conditions, such as in anemia (hematocrit), hypocalcemia (serum calcium), decreased mucle mass (serum creatinine), liver disease (BUN, total protein, albumin), poor nutritional state (BUN, total protein, albumin) and use of diuretics (urine Na). FEUrea and FELi appear to be better in assessing prerenal status in patients on diuretics.
 
 
 
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