Any preventable or potentially reversible causes must be identified. This may include obstruction, infection and use of nephrotoxic drugs. Patients with diabetes or hypertension must strive for optimal cont
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rol of blood sugar and blood pressure. The aim of treatment is to preserve as much kidney function as possible, and delay progression of kidney failure. This is done by treating the underlying cause and complications of renal failure, often with medication. However, drugs cannot reverse kidney failure.
Drugs are used to control diabetes and hypertension. Certain anti-hypertensives can slow down kidney damage especially in diabetics. Drugs are also helpful to correct fluid and electrolyte imbalances.
Important steps to prevent deterioration of kidney function are to relieve any obstruction, stop nephrotoxic drugs, treat infection, control blood pressure and reverse dehydration if present.
Anaemia is common in CRF and erythropoietin therapy can be used, often combined with iron, and sometimes with folic acid and certain vitamins. If erythropoietin therapy is started before end-stage renal failure occurs, it may delay the need for dialysis.
Dietary changes are important with the emphasis being on the limitation of phosphate and potassium containing foods. Medications that bind phosphates are prescribed during meals. This is to help control the calcium–phosphate imbalance found in CRF and to prevent renal bone disease. When renal function is severely impaired and the patient is symptomatic, dialysis is considered.
The use of a special group of antihypertensive drugs called the angiotensin converting enzyme inhibitors (ACEI) has been shown to reduce the rate of decline of kidney function and is now used whenever the diagnosis of CRF is made provided the patient can tolerate the drugs.
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