- Calcium channel blockers as verapamil and nifedipine.
- Vasodilating agents as dopamine in renal dose 1-2 ug/kg/min
- ATP-magnesium chloride.
In case of contrast media, the following additional points should be
adopted, these are:-
- Avoid unnecessary contrast procedures.
- Avoid multiple contrast exposure within a few days.
- Avoid contrast exposure in high risk patient.
- Use the smallest dose possible.
- Use of non-ionic contrast is to somewhat safer.
- In high risk patient with renal impairment we can manage to wash the
contrast out immediately after the technique (e.g. coronary
angiography) by haemodialysis.
- MRU is good alternative for visualization of the urinary tract
obstruction.
C- Conservative measures:
1- fluid balance:
Careful monitoring of intake/output and body weight is very
important to avoid overload and hypovolaemia. The first may lead to
pulmonary oedema while the second may aggravate renal ischaemia.
Patient should receive fluids equal the daily urine output plus the
other sensible losses e.g. vomitus or diarrhea fluid; plus an amount equals
the insensible loss which is around 600 c.c. for 60kg body weight patient.
For example, a 60kg b.w. patient with ARF who produces 200 c.c. urine
daily with no vomiting or diarrhea will need a daily fluid intake of about
600 + 200 = 800 c.c. With every 1°c increase in body temperature, 200
