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Diuresis and detumescence therapy for kidney syndrome

Jun 08, 2017

Diuresis and detumescence therapy for kidney syndrome
(1) thiazide diuretics: the main role in the medullary loop uplift thick wall and distal convoluted tubules, by inhibiting sodium and chlorine reabsorption, increased potassium excretion and diuretic. Commonly used hydrochlorothiazide 25mg, 3 times / d orally. Long-term use should be to prevent low potassium, hyponatremia.
(2) retention of potassium diuretics: the main role in the distal section of the small tube, row of sodium, chlorine, but potassium retention, for patients with hypokalemia. Diuretic effect alone is not significant, can be combined with thiazide diuretics. Commonly used diltiazem 50mg, 3 times / d, or aldosterone antagonist spironolactone 20mg, 3 times / d. Long-term use to prevent hyperkalemia, renal insufficiency patients should be used with caution.
(3) loop diuretics: the main role in the medullary loop ascending branch, sodium, chlorine and potassium reabsorption has a strong inhibitory effect. Common furosemide (furosemide) 20 ~ 120mg / d, or bumetanide (butyraline) 1 ~ 5mg / d (the same dose when the role of furosemide strong 40 times), pided into oral or intravenous injection. In the application of osmotic diuretics after administration of the effect is better. Application of loop diuretics should beware of hyponatremia and hypokalemia, hypochloride alkalosis occurs. kidney syndrome
(4) osmotic diuretics: through a transient increase in plasma colloid osmotic pressure, can make the tissue back to the blood into the blood, while causing renal tubular hyperosmolar state, reduce water and sodium reabsorption and diuretic. Commonly used sodium-free dextran 40 (low molecular weight dextran) or hydroxyethyl starch (706 generation of plasma, molecular weight of 25,000 to 45,000 Da), 250 ~ 500ml intravenous infusion, the next day 1 times. Followed by the use of loop diuretics can enhance the diuretic effect. But for oliguria (urine output <400ml / d) patients should be used with caution of these drugs, because of its easy with the secretion of tubules. Tamm-Horsfall protein and glomerular filtration albumin together to form a tube, blocking the renal tubules, And because of its hypertonic effect leading to renal tubular epithelial cell degeneration, necrosis, induced "osmotic nephropathy", leading to acute renal failure.
(5) to improve the plasma colloid osmotic pressure: plasma or human serum albumin and other intravenous infusion can improve the plasma colloid osmotic pressure, and promote the organization of water back to absorb and diuretic, such as immediately intravenous infusion of furosemide 60 ~ 120mg (plus In the glucose solution slowly intravenous infusion 1h), can get a good diuretic effect. Patients with hypoproteinemia and severe malnutrition can also be considered when the application of human serum albumin. But because of the input of plasma and its products will be 24 to 48h from the urine, so the plasma products can not be infused too much frequency, or because of glomerular hyperfiltration and renal tubular metabolism may cause renal glomerular Layer and renal tubular epithelial cell damage, light effects of glucocorticoid effect, delayed disease relief, severe cases can damage renal function. Patients with heart disease should be used with caution this method diuretic, so as to avoid acute expansion of blood volume induced heart failure. kidney syndrome
(6) other: severe intractable edema patients, the treatment of those who can try short-term blood ultrafiltration treatment, the implementation of the therapy can be rapidly dehydrated, severe ascites patients can also consider the strict aseptic conditions in the release of ascites, Venous return.

Diuresis and detumescence therapy for kidney syndrome

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