Renal Drugs

General principles

Acutely ill patients are at risk for developing, or exacerbating, renal dysfunction.  Good intensive care practice, and renal care, encompasses:

  • Avoiding renal hypoperfusion: intensive care unit patients generally do not have the ability to auto regulate renal blood flow and GFR, as these become increasingly dependant on systemic perfusion pressures.  For this reason urinary output is a good marker of total body perfusion, and resuscitation status.
  • Ensuring adequate volume resuscitations
  • Avoiding renal toxins if possible:  aminoglycoside antibiotics, contrast mediums etc
  • Considering local complicating conditions eg: abdominal compartment syndromes

 
Administration of agents such as dopamine in low dose, or frusemide, may help maintain urine output with some inherent advantages in fluid management.  They are not however reno-protective, and their use should be carefully weighed up in each clinical scenario.

 

Diuretics

Indications:

  • Total body salt and water fluid overload, without intravascular depletion
  • Congestive cardiac failure / cor pulmonale
  • Ascitic states where abdominal volume is thought to be a compromising factor
  • Hypertension
  • Conjunctive therapy in cardiac failure (not primarily diuretic):  ACE-I and thiazide, low dose (25 mg / day) spironolactone
  • Metabolic alkalosis:  eg, recovering ventilated COPD patients following prolonged permissive hypercapnoea, prolonged renal replacement therapy with bicarbonate overshoot, (ie: acetazolamide).

 

Contraindications:

  • Hypovolaemia
  • Anuria:  Frusemide in particular acts on the luminal side of the renal tubule.  States where there is no, or low, GFR will not respond to drug administration, and may complicate hypotension by direct afterload reduction.
  • Failure to respond to trial dose
  • Drug hypersensitivity:  NB sulphonamides

 

Complications

  • Hypovolaemia
  • Hypovolaemic hypersmolar states
  • Hyponatraemia or hypernatraemia
  • Electrolyte disturbance of K+, Mg2+ and PO43-
Page last reviewed: 14 May 2014
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