From the Guidelines
Renal rounds should cover a comprehensive assessment of patients with kidney-related conditions, focusing on fluid status, electrolyte balance, medication management, and overall kidney function. Begin by reviewing vital signs, intake and output measurements, and daily weights to evaluate volume status. Examine laboratory values including BUN, creatinine, eGFR, electrolytes (particularly sodium, potassium, calcium, phosphorus, and magnesium), acid-base status, and urinalysis results. Medication review should address nephrotoxic drugs, dose adjustments for renal impairment, and specific renal medications such as diuretics (furosemide 20-80mg daily or twice daily, depending on severity), phosphate binders (sevelamer 800mg with meals), and blood pressure medications. For dialysis patients, discuss recent treatments, ultrafiltration goals, access site condition, and any complications. Address nutritional status, including protein intake, fluid restrictions, and electrolyte limitations. Review any imaging studies or procedures and discuss the overall treatment plan, including potential for renal recovery or progression to renal replacement therapy. This comprehensive approach ensures proper management of kidney disease while preventing complications like electrolyte imbalances, volume overload, and medication toxicity that could further compromise renal function.
Some key points to consider during renal rounds include:
- Counseling patients on their kidney disease, including tumor biology and oncologic risk assessment, as well as the importance of patient age, comorbidities, and life expectancy 1
- Referring patients to nephrology when necessary, particularly those with a high risk of CKD progression or those who require genetic counseling 1
- Monitoring patients with CKD for signs of progression, such as worsening urinary albumin-to-creatinine ratio or decrease in estimated GFR, and referring to nephrology as needed 1
- Providing supportive care to patients with kidney disease, including pain and symptom management, advance care planning, and discussion of treatment options, including active medical management without dialysis 1
By prioritizing these key points and taking a comprehensive approach to renal rounds, healthcare providers can improve patient outcomes and reduce morbidity and mortality associated with kidney disease.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Renal Rounds Coverage
The following topics should be covered on renal rounds:
- Patient assessment and management plans, including blood pressure control and proteinuria reduction 2
- Disease management and treatment options for end-stage renal disease (ESRD), such as dialysis and kidney transplantation 3
- Medication management, including antihypertensive medications like lisinopril and losartan, and their dosing regimens 4
- Advance care planning and discussions about patient values and goals, particularly for patients with ESRD near the end of life 5
- Optimization of renal hemodynamics, including mean arterial pressure and renal outflow pressure, and the use of therapeutic options like vasopressors and angiotensin II 6
Key Considerations
- Controlling blood pressure and volume control through adequate dialysis and sodium restriction can help optimize hypertension treatment in patients with ESRD 3
- Monitoring for signs of protein-energy wasting and malnutrition is important for patients with ESRD 3
- Interdisciplinary teams with expertise from social work, palliative care, and hospice can be helpful in caring for patients with ESRD 5
- Measurement of renal hemodynamics can help guide therapeutic goals and mitigate the risk of acute kidney injury (AKI) 6