Nephrology Therapy

By Dr Ananya Mandal, MD

Nephrology deals with diseases of the kidneys. Medications are useful in many forms of kidney disease. Treatment of kidney diseases depends on their cause and pathology.

Autoimmune kidneys diseases

Steroid medications are immunosuppressants that suppress the aberrant immune system as well as autoimmunity. These are useful in several autoimmune kidneys diseases including lupus, vasculitis etc.

Several  autoimmune diseases also respond to disease-modifying antirheumatic drugs (DMARDs).

Other immune suppressing drugs like cyclosporine, azathoprine etc. are useful in autoimmune kidney diseases as well as in prevention of graft rejection after kidney transplants.

Kidney diseases that cause high blood pressure

High blood pressure caused due to kidney diseases respond to several classes of drugs that are useful in hypertension.

The commonest type of blood pressure medicines used in renal disease include angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta blockers, diuretics and calcium channel blockers.

ACE inhibitors (including Enalapril, Captopril etc.) and ARBs (including Losartan, Candesartan etc.) have additional protective effects on the kidney and are thus most commonly prescribed. They are used with maximum benefits in diabetic as well as hypertensive nephropathy.

Diuretics, also known as “water pills,” help in excretion of excess fluid in the body.

Long term kidney diseases

Vitamin D deficiency is common in persons with long term kidney diseases and its replacement is necessary in chronic kidney disease patients.

Erythropoietin is an important hormone that is secreted from the kidneys and helps in manufacture of blood cells. This also needs to be replaced in chronic kidney disease patients.

Electrolyte supplements and fluid supplements are often needed for electrolyte imbalances caused by kidney disease.

Renal failure and end stage renal disease

As kidney disease progresses, the patient may reach renal failure and end stage renal disease, where the kidneys are unable to clear the blood of waste products. These patients require dialysis or artificial filtering of the bloodstream.

Hemodialysis uses an external device or artificial kidney through which the blood is passed to clear it from metabolic waste products. Hemodialysis may sustain life for years in both acute and chronic kidney failure.

Another form of dialysis is peritoneal dialysis. Like hemodialysis, peritoneal dialysis also removes metabolic wastes from blood via a catheter placed in their abdomen or peritoneal cavity. This may useful for both acute and chronic kidney failure.

Kidney transplant

Patients with end stage renal disease may need a donor kidney to replace their own. The donor kidney needs to be matched to the recipient in order to reduce the risk of the body failing to recognize it as a foreign organ and attacking it.

This damage to the donor organ caused by the body’s immune system is called graft rejection.

Reviewed by , BA Hons (Cantab)

Sources

  1. http://www1.mans.edu.eg/pcvs/14122/Essentials_of_clinical_nephrology.pdf
  2. http://fds.oup.com/www.oup.co.uk/pdf/medicine/otcn3prelims.pdf
  3. http://www.unckidneycenter.org/nephnursingabout.pdf
  4. http://www.med.umich.edu/intmed/resident/curric/Nephrology.pdf

Further Reading

Last Updated: Jul 14, 2013

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