Potter Syndrome Medication

Updated: Jan 21, 2015
  • Author: Sushil Gupta, MD; Chief Editor: Craig B Langman, MD  more...
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Medication

Medication Summary

Multiple medications are typically indicated in patients with acute or chronic renal failure. The treatment should address fluid and electrolyte disturbances, hypertension, anemia, calcium and phosphorus disorders, and growth failure.

Treatment regimens for hypertension are designed to reduce blood pressure and other risk factors of coronary heart disease. Diuretic agents help relieve fluid overload associated with renal failure. Additional pharmacotherapy for hypertension associated with renal failure should be individualized based on the patient's age, race, known pathophysiologic variables, and concurrent conditions. Treatment goals are not only to lower blood pressure safely and effectively but also to prevent or reverse hyperlipidemia, glucose intolerance, and left ventricular hypertrophy. For complete information, see the pediatric topics Hypertension and Neonatal Hypertension.

Erythropoietin is essential for red blood cell production and may be required because of decreased erythropoietin levels in renal failure. Vitamin D analogs are essential to provide homeostasis for calcium regulation. Growth hormone may be required because of inadequate growth in children with renal failure.

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Pituitary hormones

Class Summary

The anterior lobe of the pituitary gland is responsible for the secretion of adrenocorticotrophic hormone (corticotropin); gonadotrophic hormones (gonadotropins), including follicle-stimulating hormone and luteinizing hormone; growth hormone (somatropin); lactogenic hormone (prolactin); and thyroid-stimulating hormone (thyrotropin). The secretion of anterior pituitary hormones is regulated by a complex interaction between stimulatory and inhibitory neural and hormonal influences. Hypothalamic releasing factors stimulate the release of anterior pituitary hormones into the systemic circulation. Some pituitary hormones (eg, growth hormone) are controlled with a system of double regulation (ie, the hypothalamus secretes a release-inhibiting factor).

Human growth hormone (Genotropin, Humatrope, Nutropin, Serostim, Saizen)

Used to treat inadequate growth in children with chronic renal failure. Stimulates growth of linear bone, skeletal muscle, and organs. Stimulates erythropoietin, which increases red blood cell mass.

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Erythropoietin

Class Summary

Glycoprotein is normally produced in the kidneys. It is responsible for the stimulation of red blood cell production. Anemia occurs because of deficient erythropoietin production during renal failure.

Epoetin alfa (Epogen, Procrit)

Derived via recombinant DNA techniques. The amino acid sequence is identical to that of endogenous erythropoietin. Stimulates division and differentiation of committed erythroid progenitor cells; induces reticulocyte release from bone marrow into blood stream.

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Colony-stimulating Factor

Darbepoetin (Aranesp)

Darbepoetin is used in anemia associated with chronic kidney disease. It is also used for the treatment of chemotherapy-induced anemia in patients with nonmyeloid malignancies. It is an erythropoiesis-stimulating protein closely related to erythropoietin, a primary growth factor produced in kidney that stimulates the development of erythroid progenitor cells.

The mechanism of action is similar to that of endogenous erythropoietin, which interacts with stem cells to increase red blood cell production. It differs from epoetin alfa (recombinant human erythropoietin) in containing 5 N-linked oligosaccharide chains, whereas epoetin alfa contains 3. It has a longer half-life than epoetin alfa (may be administered weekly or biweekly).

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Diuretic agents

Class Summary

Diuretic agents promote the excretion of water and electrolytes by the kidneys. They are used to treat heart failure or hepatic, renal, or pulmonary disease when sodium and water retention results in edema or ascites. They may be used as monotherapy or in combination to treat hypertension. In renal failure, hypertension is due to fluid overload.

Furosemide (Lasix)

Increases excretion of water by interfering with chloride-binding cotransport system, which in turn inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. Dose must be individualized to the patient.

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Vitamin D analogs

Class Summary

These agents regulate serum calcium via their actions on calcium and phosphorus metabolism at intestinal, renal, and skeletal sites. The kidney appears to play a central role in this system. It produces calcitriol (ie, 1,25-dihydroxyvitamin D, the primary active metabolite of vitamin D3), which acts on distal organs; at the same time, it is the target organ of PTH; calcitonin; and, possibly, calcitriol.

Calcitriol (Rocaltrol)

Vitamin D analog used in the treatment of vitamin D deficiency. Increases calcium levels by promoting the absorption of calcium in the intestines and its retention in kidneys

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Antacid

Calcium carbonate

Calcium carbonate successfully normalizes phosphate concentrations in dialysis patients. It combines with dietary phosphate to form insoluble calcium phosphate, which is excreted in feces. It is marketed in a variety of dosage forms and is relatively inexpensive.

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