Renal Cortical Necrosis Medication

Updated: Nov 03, 2015
  • Author: Prasad Devarajan, MD, FAAP; Chief Editor: Craig B Langman, MD  more...
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Medication

Medication Summary

The restoration of hemodynamic stability may require use of intravenous (IV) crystalloids, colloids, blood products, and/or pressors to maintain blood pressure and cardiac output.

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Electrolytes

Class Summary

These agents are used to maintain blood pressure and cardiac output.

Lactated Ringer with Normal Saline

Lactated Ringer is essentially isotonic and has restorative properties. It restores interstitial and intravascular volume.

Normal saline

Normal saline is used for restoration of interstitial and intravascular volume.

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Colloids

Class Summary

These agents are used for volume expansion to treat shock. They are preferred over crystalloids because the excessive administration of fluids can lead to extravasation caused by vascular leak, especially during the febrile and hypotensive stages.

Albumin (Albuminar, AlbuRx, Albutein, Flexbumin, Plasbumin)

Albumin is used for certain types of shock or impending shock. It is useful for plasma volume expansion and maintenance of cardiac output. Although theoretically attractive, the benefit of colloid resuscitation over isotonic crystalloids is not proven.

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Vasopressors

Class Summary

These agents maintain blood pressure and cardiac output in patients with renal cortical necrosis.

Dopamine

Dopamine stimulates both adrenergic and dopaminergic receptors. The hemodynamic effect depends on the dose. Low doses predominantly stimulate dopaminergic receptors, which, in turn, produce renal and mesenteric vasodilation. High doses produce cardiac stimulation and renal vasodilation. After initiating therapy, increase the dose by 1-4 mcg/kg/min every 10-30 minutes until an optimal response is obtained. Maintenance dosing at less than 20 mcg/kg/min is satisfactory in greater than 50% of patients.

Norepinephrine (Levophed)

Norepinephrine is used in protracted hypotension after adequate fluid replacement. It stimulates beta1- and alpha-adrenergic receptors, which, in turn, increases cardiac muscle contractility and the heart rate, as well as vasoconstriction. As a result, it increases systemic blood pressure and cardiac output. Adjust and maintain the infusion to stabilize blood pressure (eg, 80-100 mm Hg systolic) sufficiently to perfuse vital organs.

Vasopressin (Pitressin)

Vasopressin has vasopressor and antidiuretic hormone (ADH) activity. It increases water resorption at the distal renal tubular epithelium (ADH effect) and promotes smooth muscle contraction throughout the vascular bed of the renal tubular epithelium (vasopressor effects). Vasoconstriction is also increased in splanchnic, portal, coronary, cerebral, peripheral, pulmonary, and intrahepatic vessels.

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