Complete! Manual on medication education for children with renal impairment

Basic knowledge about kidneys

1. What is the structure and function of the kidneys? The kidneys are paired organs located on both sides of the spine behind the peritoneum. Their main function is to filter waste products from the blood, which, along with excess water, form urine.

The structure of the kidney is very complex. The basic structure is the nephron, which includes the renal capsule, glomerulus, renal tubule, etc.

1. What is kidney damage? Kidney damage includes acute kidney damage and chronic renal failure. Acute kidney damage is often caused by certain triggers. Specific drugs, contrast agents, certain foods or toxic substances can lead to a sudden drop in glomerular filtration rate, causing azotemia, water electrolyte and acid-base balance and systemic symptoms, which may be accompanied by oliguria or anuria. Active treatment can usually recover. Chronic kidney disease refers to kidney damage with a history of more than 3 months. Before symptoms appear, there is often a long asymptomatic period. Due to the long history of the disease, kidney damage is mostly irreversible. Treatment is to delay the progression of the disease through drug and lifestyle intervention, and the final result is blood purification replacement therapy.

Drug safety tips 1. Drugs that may cause kidney damage

(1) Antibiotics Kidney damage caused by antibiotics is mainly an allergic reaction caused by drugs or active metabolites. Many antibiotics are potentially toxic, and their damaging effects worsen with increasing doses and prolonged treatment courses, especially when large doses of combined drugs are used, drugs are used irrationally, and drugs are abused. Kidney toxicity caused by antibiotics mainly refers to reversible proteinuria, hematuria, cadmium, azotemia, oliguria, and anuria.

Aminoglycosides: including gentamicin and amikacin. Nephrotoxicity is closely related to drug dose and drug accumulation in the renal cortex. The higher the drug concentration, the greater the nephrotoxicity.

Antifungal drugs: including fluconazole and amphotericin B. They are highly nephrotoxic and can cause constriction of the renal afferent and efferent arterioles, reduce renal blood flow and glomerular filtration rate, and lead to acute and chronic renal function damage.

Sulfonamides: The renal damage caused by the drugs is mainly due to crystallization in the renal tubules, causing hematuria and obstructive nephropathy.

(2) Chinese herbal medicines are the main cause of nephrotoxicity when used in large doses within a short period of time. In addition, some drugs are slowly excreted from the body and can cause cumulative toxicity if taken for a long time, such as causing lesions in the glomeruli and interstitium.

When Chinese medicine causes kidney damage, the symptoms vary, usually systemic symptoms and urinary system symptoms. Systemic symptoms include fatigue, loss of appetite, skin itching, etc., while urinary system symptoms are mainly renal failure and various nephritis.

Depending on how fast the disease progresses, it can cause acute and chronic renal failure. Acute renal failure often occurs within a short period of time after taking Chinese medicine, often with obvious gastrointestinal symptoms, and azotemia, oliguria, and anuria quickly appear. The prognosis is generally good, and recovery can often be achieved by stopping the drug in time and providing supportive treatment. Chronic renal failure has an insidious onset and develops progressively, often manifested as tubular interstitial fibrosis, and the lesions are difficult to reverse.

(3) Other contrast agents: 98% of iodine contrast agents are excreted through the kidneys, which can cause strong renal vasoconstriction and lead to ischemic and hypoxic damage. They can also cause osmotic diuresis and increase the workload of renal tissue. They manifest as non-oliguric acute renal failure. The renal function of most patients can return to normal within 7 to 10 days.

Chemotherapeutic drugs: especially cisplatin, when the optimal dose for anticancer activity is reached, renal toxicity will also occur. The normal dose mainly produces renal tubular damage, and repeated high doses can cause persistent mild to moderate renal damage.

1. Overview of Treatment of Kidney Injury Immediate treatment—Treatment of life-threatening fluid and electrolyte abnormalities caused by acute kidney injury should be started immediately.

(1) Volume issues - Unless there are contraindications, patients should receive intravenous fluid therapy as long as they have a history of fluid loss (such as vomiting and diarrhea) and physical examination findings consistent with hypovolemia.

(2) Hyperkalemia - Hyperkalemia has few symptoms and signs, often only occurs when serum potassium levels are very high, and is associated with impaired neuromuscular conduction and cardiac conduction abnormalities. In general, all patients with acute kidney injury with drug-refractory hyperkalemia should receive dialysis.

(3) Metabolic acidosis - In cases of metabolic acidosis caused by reduced glomerular filtration rate, the kidney's ability to excrete acid and regenerate bicarbonate is impaired. Common treatments include dialysis and administration of bicarbonate. The choice of treatment for patients with acute kidney injury depends on whether there is volume overload and the underlying cause and severity of the acidosis.

(4) Indications for dialysis therapy - Patients with acute kidney injury who have fluid overload refractory to diuretics, hyperkalemia that is unresponsive to drug therapy, severe metabolic acidosis, and signs of uremia should undergo dialysis therapy.

1. Principles of medication for kidney damage (1) There are clear indications for medication. All medicines are toxic, especially prescription drugs. You need to consult a doctor and weigh the pros and cons before taking them. Do not overuse drugs. For example, if you want to kill bacteria as quickly as possible, you may double the dose of antibiotics without authorization. This will not only fail to double the therapeutic effect, but will also increase the burden on the liver and kidneys.

(2) Choose drugs with relatively small nephrotoxicity and avoid using combination drugs that have synergistic nephrotoxic effects. Ensure that the dosage is within the recommended dosage range in the instructions.

(3) Achieve early detection during treatment and strengthen monitoring of patients using nephrotoxic antibiotics, including symptoms and signs, urine routine, renal function, etc.

(4) Once a drug is found to cause kidney damage and the above symptoms occur, you need to seek medical attention promptly and stop taking the drug if necessary.

For patients with renal insufficiency, the dosage of the drug should be reduced according to the severity of the renal impairment. Even if a drug with certain toxicity to the kidney is used, the dosage can be properly adjusted to avoid renal impairment. It is generally believed that endogenous creatinine clearance (CCr) is a reliable method for measuring renal function, and it is inversely proportional to the half-life of the drug in the serum.

According to the elimination characteristics of antimicrobial drugs themselves, they can be mainly divided into three categories:

(1) Drugs that are basically eliminated through renal excretion, such as cephalosporins, aminoglycosides, etc.;

(2) Some drugs are eliminated by both renal and non-renal pathways, with the amount of unchanged drug eliminated by the kidneys accounting for about 50% of the administered dose, such as carbenicillin and lincomycin.

(3) Drugs that are basically eliminated through the liver and other non-renal pathways, with non-renal elimination >80%, such as isoniazid;

For drugs in categories (1) and (2), renal clearance is reduced due to renal failure. If the original dose is continued, drug accumulation and toxicity may occur. For drugs in category (2), renal clearance can be compensated by other means and is only slightly affected. Therefore, it is not necessary to adjust the dose in the case of renal failure.

The main methods of dose adjustment are dose reduction and extended interval dosing. The dose reduction method is to keep the first dose unchanged and the interval between two doses unchanged to reduce the maintenance dose; the extended interval dosing method is to keep the single dose of the drug unchanged and extend the dosing interval. For specific adjustment methods for a particular drug, please refer to the Guidelines for Dosage Adjustment in Renal Insufficiency.

Life management of chronic kidney disease: changing unhealthy lifestyles

Eat a healthy diet, control your weight, and avoid consuming large amounts of high-protein foods or excessive drinking of carbonated beverages. Take breaks, exercise appropriately, and strengthen your body, but avoid high-intensity, long-term exercise. Drink water in moderation and urinate in time.

Dietary considerations: Patients with chronic kidney disease need to limit protein intake. Depending on the stage of chronic kidney disease, there are different restriction requirements.

Chronic kidney disease can easily cause hyperphosphatemia. Phosphorus is mainly taken in through food, so a low-phosphorus diet can be adopted. High-protein foods have a high phosphorus content, so reducing protein intake can also help reduce phosphorus.

High-phosphorus foods (phosphorus content per 100g from high to low): chrysanthemum chrysanthemum, pea sprouts, winter bamboo shoots, cauliflower, red dates, rapeseed, straw mushrooms, spinach, soybean sprouts, carrots, kohlrabi, cherry tomatoes, water spinach, bananas, strawberries, kiwis, cantaloupes, plums, and Hami melons

Chronic kidney disease patients have reduced potassium excretion and should avoid excessive consumption of foods high in potassium to prevent elevated blood potassium. High potassium foods (phosphorus content per 100g from high to low):

Mushrooms, cabbage, milk powder, soybean powder, seaweed, carrots, potatoes, raisins, spinach, onions, red beans, whole milk powder, kelp, lamb, nuts, bananas

1. Drug usage Clinical drug use tips

Once Daily: Take the medicine once at the same time each day.

Twice a day: Take the medicine once in the morning and once in the evening, 12 hours apart. For example: 8 am and 8 pm.

3 times a day: Take the medicine once in the morning, afternoon and evening, about 8 hours apart. For example: 6 am, 2 pm, 1 pm

Take medication at 10 o'clock.

4 times a day: Take the medicine once in the morning, noon, evening and before going to bed. For example: 8 am, 12 pm, 4 pm,

8pm.

All at once: Take the daily dose of medicine at one time.

Take on an empty stomach: Take the medicine 1 hour before or 2 hours after a meal.

Take with meals: refers to taking the medicine with or at the same time as a meal. Take before meals: usually refers to taking the medicine 15 to 30 minutes before a meal.

Take after meal: usually take the medicine 15 to 30 minutes after meal. Take before bed: usually take the medicine 15 to 30 minutes before bed.

Sublingual: Place the tablet under the tongue to dissolve and absorb. Do not chew or swallow. Do not swallow saliva until the tablet is absorbed.

1. What should I do if I miss a dose of medicine? If you miss a dose of medicine for various reasons, do not take it at will. It depends on the situation:

If you miss a dose within half of the interval between two doses, you should take the original dose and take the next dose according to the original interval and dose.

If you miss a dose more than halfway between two doses, you do not need to make up for it. You should take the next dose according to the original time interval and dosage. You should not double the dose because of a missed dose.

For example, if a patient should take one pill at 8 a.m. and one at 8 p.m., but misses taking the pill at 8 a.m.,

If you remember before 2 p.m., you can take 1 more pill and take 1 more pill at 8 p.m.; if you remember after 2 p.m.,

No need to make up for the loss of your period. Just take 1 tablet of the original dose at 8pm.

1. Drug storage method: Normal temperature: a place with a temperature of 10-30°C. Especially in summer, be careful not to store the drugs at too high a temperature. If this is not possible, it is recommended to refrigerate.

Cool place: a place where the temperature does not exceed 20°C. Cold place: a place where the temperature is between 2 and 10°C.

Light-shielding: Packaging in light-proof containers, often used to store medicines that are easily changed by light. Sealing: Sealing the container to prevent dust or foreign matter from entering.

1. Correctly understand adverse drug reactions What are adverse reactions? Adverse reactions refer to harmful reactions that are unrelated to the purpose of medication and occur when qualified drugs are used in normal dosage and usage. They are neither drug quality issues nor medical accidents.

Do adverse reactions need to be treated? Most drugs, especially when used for a long time or in large doses, may cause adverse reactions in patients to a greater or lesser extent. If the adverse reaction is mild, you can continue to take the drug according to the prescription. It is not appropriate to reduce the dosage of the drug to reduce the adverse reaction.

If serious adverse reactions occur (sometimes with obvious symptoms and sometimes only indicated by laboratory tests), you need to see a doctor or consult a doctor and pharmacist immediately. The dosage may need to be adjusted, or another drug may need to be replaced depending on the situation.