Pharmacotherapy of Common Renal Disorders

(i)Acute Renal Failure (ARF)- a rapid decline in renal function manifesting itself most commonly as an increase in serum concentration of creatinine, can be caused by:

       (a). Obstruction of renal arteries, not amenable to drug therapy but often associated with hypertension which can be controlled with medication to be discussed in another lecture.

       (b). Glomerulonephritis, precise aetiology is unknown but can be treated with immunosupressents such as the corticosteroid prednisilone.

       (c). Acute tubular necrosis, wherein an ischaemic insult to the kidney progresses to cell death. Patients can be divided into oliguric and non-oliguric (with the latter suffering less symptoms). Mannitol and loop diuretics have proven useful in treating pigment induced ARF and there is debate as to there use in other types of tubular necrosis. Renal dose dopamine (<3ug/Kg/min) is used in patients thought to be at risk of necrosis and a dose this low avoids systemic effects.  

(ii)Chronic Renal Insufficiency- Decline in renal function due to an insult (eg, hypertension, diabetes mellitis) causong an inexorable progression to renal dysfunction. Pharmacotherapy is aimed at preserving function by treating the primary diseases and also to slow deterioration so calcium carbonate or calcium acetate are used to bind potassium and supply calcium, genetically engineered erythropoietin is given to restore red cell mass within 12 weeks and diuretics are used to combat sodium accumulation.  

(iii)Urinary Tract Infections- infection from urethra to kidneys. Urine must be cultured and the subsequent infection treated with the appropriate antibiotics and regimens.  

(iv)Urinary Tract Stones- can be formed from many things including calcium, uric acid, cystine, oxalate etc... Treatment requires knowing what the stone's formed from and if there is underlying hypersecretion of the substance and then treat this. The clinician must also consider whether to treat with medication as the median time of calcium stone reoccurrence is 7 years, and it's not all about giving drugs you know.