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Handbook of elderly patients with nephrotic syndrome

Apr 28, 2017

Elderly patients with kidney disease medication should not only consider the physiological changes caused by aging, but also consider the body as the main organ of drug excretion - changes in renal function. Medication should pay attention to the following aspects: pay attention to the characteristics of the elderly medication, patients with kidney disease medication must pay attention to understand the characteristics of drugs.

First of all, to understand the pharmacokinetic properties of drugs, such as drugs in the form of raw or excreted by the kidney metabolites, easy to accumulate in the body lead to poisoning, need to reduce the use of. Some drugs, such as doxycycline, are excreted mainly by waste, and the use of drugs in patients with kidney disease does not lead to accumulation in the body. Sulfa drugs can form urinary crystals, easily lead to urinary tract obstruction, so that further deterioration of renal function, should avoid the use of.

Secondly, to understand the potential side effects, such as vancomycin, gentamicin, amikacin, tobramycin, streptomycin and some cephalosporins, polymyxin, vancomycin, amphotericin B and other drugs, these drugs have certain renal toxicity, kidney disease patients should be used with caution, must use should pay attention to adjust the dose. Although some drugs have kidney toxicity, but because of these drug allergy patients can cause kidney damage, such as penicillin can cause acute interstitial nephritis, manifested as fever, rash, eosinophilia, Shao Niao, renal insufficiency, also have to be careful.
There are commonly used cold drugs, painkillers, if long-term use can inhibit the activity of renal tubular cells and renal tubular direct toxic side effects, and sometimes cause allergic reactions in kidney tissue, such drugs should be used with caution. Note that the amount of drugs with the aging of the body, the function of the organ system of the elderly will be significantly reduced. Gastrointestinal function is poor, easy to cause gastrointestinal reaction, after taking, reduce hepatic drug metabolizing enzymes activities, decreased drug metabolism ability; renal function in the elderly are young people, and people with kidney disease, renal excretion of drug reduced lead to drug accumulation in the body.

Therefore, elderly patients with kidney disease should pay attention to adjust the dosage of drugs, should start from a small dose, according to the effect of gradual adjustment. Adjust the dosage can be carried out in the following two ways:

1. Daily or every agent dosage, dosage unchanged, changes in mild renal function according to the normal dose of 2 / 3 to 1 / 2 medication, moderate changes according to the normal dose of 1 / 2 to 1 / 5 dosage, weight change in the normal dose were 1 / 5 to 1.

2. The time of administration was prolonged and the dosage was unchanged. For a strong, high security, small range of drugs, such as aminophylline, cardiac glycosides, dose adjustment should pay special attention to the condition allows, it is best to monitor the blood concentration, adjust the drug dose. All drugs should not be too long, to achieve the effect should be timely attention to disable. Elderly people often pay attention to drug types and various diseases there are a variety of symptoms of the disease, drug treatment should pay attention to the priority conditions, not necessarily in the various symptoms of each disease of drugs and drug treatment, can deal with the situation in a certain period of time the problem is an urgent need to improve the treatment of these drugs, suspend the other disease.

Especially the elderly patients with nephropathy and other chronic diseases, such as chronic hepatitis, liver cirrhosis, hypertension, diabetes, hypoproteinemia, adverse drug reactions and more serious consequences, the medication process must closely observe the side effects of drugs, serious side effects, should be promptly discontinued.

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