556 UNIT VIII RENAL AND UROLOGICAL DISORDERS
Patho-Pharm Connection
Continual secretion of renin-angiotensin-aldosterone system hypertension: ACE inhibitors (ACEi) or angiotensin receptor blockers (ARBS)
Glucose metabolism dysfunction: gliflozin (SGLT2 inhibitor) antidiabetic agent (e.g., dapagliflozin) is renoprotective
Lack of acid-base balance Sodium bicarbonate
metabolic acidosis:
Oliguria hypervolemia: Loop diuretics (e.g., furosemide)
Electrolyte imbalances: Hyperkalemia: Patiromer Hyperphosphatemia: Phosphate binders (e.g., PhosLo) Hypocalcemia: Calcium supplement
Lack of erythropoietin
anemia
Erythropoiesis stimulating agent (e.g., epoetin-alfa) Iron supplements
Lack of vitamin D
lack of GI absorption
Dermatologic pruritus: Topical corticosteroids Antihistamines
of calcium
hypocalcemia
stimulation
of parathyroid glands
PTH
bone
breakdown: Calcitriol (vitamin D) Calcimimetic (e.g., cinacalcet) lowers PTH
necessary. There is constant stimulation of the parathyroid glands in kidney failure; therefore, calcimimetic medica- tions can decrease parathyroid hormone (PTH). Glucose metabolism is disrupted with kidney failure; therefore, glifozin-type antidiabetic agents are used. Electrolyte dis- turbances occur such as hyperkalemia, hypocalcemia, and hyperphosphatemia. Patiromer lowers blood potassium level, phosphate binders lower PO 4 – , and calcium supple- ments can be given. Acid-base balance is not maintained when the kidneys fail and metabolic acidosis occurs. Sodium bicarbonate can counteract acidosis. The nerve endings become hypersensitive due to excess urea in the bloodstream causing pruritus (itching). Topical corticoste- roids and antihistamines can be used.
Renal failure causes multiple systemic complications. Pharmacological agents are used to counteract the poten- tial adverse effects. With the kidneys not functioning, fluid balance is disturbed and hypervolemia can occur. Loop diuretics can enhance water loss from the body. The failing kidney does not secrete erythropoietin; therefore, epoetin- alfa (synthetic erythropoietin) is administered. This stimulates RBC production, which requires iron supple- mentation. Blood pressure (BP) is not controlled when the kidneys fail; HTN occurs due to constant secretion of renin. Therefore, antihypertensive medications such as ACE inhibitors or angiotensin receptor blockers are commonly used to control BP. Vitamin D is not produced when the kidneys fail; therefore, Calcitriol (vitamin D supplement) is
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