How would you manage this patients Renal failure/ deterioration?

In 6 easy steps;

1) Treat and investigate any reversible causes;

Theses include;

Pre-Renal - CCF, Dehydration, Hypertension, Hypercalcaemia, Hyperuricaemia

Renal- Infection, Interstitial Nephritis

Post-Renal- Obstruction

2) Treat the underlying disease e.g. glomerulonephritis

3) Prevent further deterioration by

Treating hypertension

Monitoring Diabetes

Preventing Infection

4) Minimising and treating complications of Renal Failure

Electrolyte/ fluid disturbance e.g. fluid restrictions may be necessary

Anaemia e.g. EPO, Folate, Fe, Transfusion, rule out blood loss, Bone Marrow depression, Chronic Disease (Aim to keep ferritin > 100 before EPO intro)

Bone Diseasee.g. may need phosphate binders, parathyroidectomy (usually if symptomatic and PTH >30, Increased Ca)

5) Minimise and treat diseases potentiated/ exacerbated by Renal Failure

Vascular risk factors

Peripheral Neuropathy

Immunosuppression

Nutrition, do not protein restrict as nutrition is more important

6) Renal Replacement Therapy

Dialysis e.g. HD vs PD

Home vs Satellite vs Hospital

Access issues

Complications

Transplant issues