Nephrology Book


Edema in Chronic Renal Failure

Aka: Edema in Chronic Renal Failure
  1. Management: Excess Sodium Intake
    1. Measure Urine Sodium excretion
    2. Increase Dietary Sodium restriction if >100 meq/day
  2. Management: Decreased, delayed intestinal drug absorption
    1. Bowel wall edema can reversibly impair oral absorption
    2. Switch to IV Loop Diuretic if high-dose oral fails
  3. Management: Decreased drug entry into tubular lumen
    1. Increase to maximum effective dose of a Loop Diuretic
      1. Lasix 160-200 mg IV
      2. Bumex 4-5 mg IV
    2. Special Circumstances
      1. Hepatic Cirrhosis: Spironolactone
      2. Hypoalbuminemia: Administer albumin and Loop Diuretic
  4. Management: Increased distal reabsorption
    1. Multiple daily Diuretic doses if partial response
    2. Supplement Loop Diuretic
      1. Add Thiazide Diuretic or
      2. Add Potassium sparing Diuretic
  5. Management: Decreased loop Sodium delivery
    1. Mechanisms
      1. Low Glomerular Filtration Rate
      2. Enhanced proximal reabsorption
    2. Increase delivery out of proximal tubule
      1. Acetazolamide
      2. Corticosteroids
    3. Diuretic administration in supine or Trendelenburg
  6. Severe Renal Failure or secondary CHF
    1. Dialysis or hemofiltration

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