Kidney and urological disorders

Fluid overload in chronic kidney disease

Resistant fluid overload in CKD is persistent volume retention despite salt restriction and diuretics, causing oedema, hypertension and heart failure. Restrict salt, use loop diuretics (furosemide or torsemide) with a thiazide or metolazone, IV furosemide (with albumin if hypoalbuminaemic) for refractory cases, and refer for nephrology or dialysis.

Vaccination in chronic kidney disease

People with CKD have weakened immunity, so vaccination prevents serious infections and hospital admissions. Hepatitis B vaccination uses higher doses in advanced CKD and dialysis (40 micrograms) with boosters when anti-HBs falls below 10 mIU/ml.

Hyponatraemia

Hyponatraemia is serum sodium below 135 mmol/L, from mild headache and nausea to seizures and coma below 125; it may be hypovolaemic, euvolaemic or hypervolaemic. Treat the cause – saline for volume loss, fluid restriction for SIADH, furosemide for overload, 3% saline for severe symptoms – and never correct by more than 8 mmol/L in 24 hours.

Peritoneal dialysis catheter-related infections and peritonitis

Peritoneal dialysis patients can develop exit-site infection, tunnel infection or peritonitis (abdominal pain, fever, cloudy effluent with over 100 white cells/µl). Treat exit-site infection with oral amoxicillin-clavulanate or cefalexin, peritonitis with intraperitoneal vancomycin plus ceftazidime or cefepime, and remove the catheter in fungal, refractory or relapsing infection.