The effect of renal failure on drug handling in critical illness

2016 ◽  
Author(s):  
Myrna Y. Munar ◽  
Ali J. Olyaei
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Impaired Renal Function ◽  
Plasma Concentrations ◽  
Kidney Injury ◽  
Specific Patient ◽  
Diagnostic Agents ◽  
Developing Kidney ◽  
Drug Handling

The kidneys play an important role in the elimination of many drugs. In chronic kidney disease and acute kidney injury several pharmacokinetic processes are altered. Thus, patients with impaired renal function require adjustment of medication dosing. Many drugs require a loading dose to rapidly achieve therapeutic plasma concentrations. Subsequently, the dose or dosing interval may have to be adjusted as appropriate for the degree for renal function. The most common method to estimate renal function is use of the Cockcroft–Gault (CG) equation. It has been well validated, is easy to remember, and is fairly accurate in estimating kidney function. Most drugs are dosed based on the patient’s weight (mg/kg), which makes the CG method easier to use for most estimates. Other methods are available and a patient’s renal function should always be estimated based on the best available evidence for that specific patient. Patients with chronic kidney disease are at great risk of developing kidney injury from drugs or diagnostic agents. Exposure to nephrotoxins should be avoided as much as possible.

scholarly journals Mandibular Osteonecrosis Induced by Bisphosphonates in a Carrier of Chronicle Kidney Disease

2018 ◽  
Vol 4 (1) ◽  
pp. 1119-1125
Author(s):  
Kaohana Da Silva ◽  
Greison De Oliveira ◽  
Eleonor Garbin-Júnior ◽  
Natasha Magro-Érnica ◽  
Geraldo Griza ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Multiple Myeloma ◽  
Renal Function ◽  
Bone Resorption ◽  
Kidney Disease ◽  
Impaired Renal Function ◽  
Clinical Case ◽  
Treatment Protocol ◽  
Inorganic Pyrophosphate ◽  
Jaw Osteonecrosis

The bisphosphonates are synthetic substances of inorganic pyrophosphate that have been the basis of treatment of patients with osteolytic diseases, such as multiple myeloma, malignant hypercalcemia, Paget's disease, or patients with bone metastases. Its main pharmacological effect is inhibition of bone resorption caused by osteoclasts, which have a reduced function. Their adverse effects are infrequent but include pyrexia, impaired renal function, hypocalcemia, and more recently, maxillo-mandibular ostenecrose induced bofosfonatos. In this report we describe a clinical case of jaw osteonecrosis induced by bisphosphonates in patient with chronic kidney disease and the treatment protocol performed.

Risk of Stroke, Bleeding, and Death in Patients with Nonvalvular Atrial Fibrillation and Chronic Kidney Disease

Cardiology ◽  
2020 ◽  
Vol 145 (3) ◽  
pp. 178-186
Author(s):  
Yoav Arnson ◽  
Moshe Hoshen ◽  
Adi Berliner-Sendrey ◽  
Orna Reges ◽  
Ran Balicer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Impaired Renal Function ◽  
Bleeding Risk ◽  
Intracranial Bleeding ◽  
Increased Risk ◽  
Ckd Stage ◽  
Stroke Death

Introduction: Atrial fibrillation (AF) and chronic kidney disease (CKD) are both associated with increased risk of stroke, and CKD carries a higher bleeding risk. Oral anticoagulation (OAC) treatment is used to reduce the risk of stroke in patients with nonvalvular AF (NVAF); however, the risk versus benefit of OAC for advanced CKD is continuously debated. We aim to assess the management and outcomes of NVAF patients with impaired renal function within a population-based cohort. Methods: We conducted a retrospective observational cohort study using ICD-9 healthcare coding. Patients with incident NVAF between 2004 and 2015 were identified stratified by CKD stage. We compared treatment strategies and estimated risks of stroke, death, or any major bleeding based on CKD stages and OAC treatment. Results: We identified 85,116 patients with incident NVAF. Patients with impaired renal function were older and had more comorbidities. OAC was most common among stage 2 CKD patients (49%) and least in stages 4–5 CKD patients (27.6%). Higher CKD stages were associated with worse outcomes. Stroke rates increased from 1.04 events per 100 person-years (PY) in stage 1 CKD to 3.72 in stages 4–5 CKD. Mortality increased from 3.42 to 32.95 events/100 PY, and bleeding rates increased from 0.89 to 4.91 events/100 PY. OAC was associated with reduced stroke and intracranial bleeding risk regardless of CKD stage, and with a reduced mortality risk in stages 1–3 CKD. Conclusion: Among NVAF patients, advanced renal failure is associated with higher risk of stroke, death, and bleeding. OAC was associated with reduced stroke and intracranial bleeding risk, and with improved survival in stages 1–3 CKD.

Renal disease

2018 ◽  
Author(s):  
Quentin Milner
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Renal Disease ◽  
Replacement Therapy ◽  
Impaired Renal Function ◽  
Anaesthetic Management

This chapter describes the anaesthetic management of the patient with renal disease. The topics include estimation of renal function, chronic kidney disease, renal replacement therapy (including haemodialysis), acute renal failure, and the patient with a transplanted kidney. For each topic, preoperative investigation and optimization, treatment, and anaesthetic management are described. The effects of impaired renal function on the elimination of anaesthetic drugs are discussed.

scholarly journals Acute kidney injury pathology and pathophysiology: a retrospective review

2020 ◽  
Author(s):  
Joseph P Gaut ◽  
Helen Liapis
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Disease ◽  
Renal Biopsy ◽  
Retrospective Review ◽  
Patient Management ◽  
Kidney Injury ◽  
High Morbidity ◽  
Underlying Pathology

Abstract Acute kidney injury (AKI) is the clinical term used for decline or loss of renal function. It is associated with chronic kidney disease (CKD) and high morbidity and mortality. However, not all causes of AKI lead to severe consequences and some are reversible. The underlying pathology can be a guide for treatment and assessment of prognosis. The Kidney Disease: Improving Global Outcomes guidelines recommend that the cause of AKI should be identified if possible. Renal biopsy can distinguish specific AKI entities and assist in patient management. This review aims to show the pathology of AKI, including glomerular and tubular diseases.

Kidney disease

2019 ◽  
pp. 317-342
Author(s):  
Debasish Banerjee ◽  
Robin Ramphul ◽  
David Goldsmith
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Drug Therapy ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Evidence Based ◽  
Altered Physiology ◽  
European Society Of Cardiology ◽  
Drug Handling

The cardiovascular disease profile in patients with chronic kidney disease, and liver disease and during pregnancy is different from that in the general population. Due to altered physiology in these conditions, drug handling is different. Hence, drug therapies in these conditions are described separately in this section. Cardiovascular disease is the commonest cause of morbidity and mortality in patients with chronic kidney disease. Yet drug therapy is often withheld or used in inappropriate doses. The kidneys have a major role in the pharmacokinetics of numerous drugs, and hence the renal function determines the dose and effect of these drugs. This chapter describes common cardiovascular events in chronic kidney disease patients and appropriate drug therapy. Evidence-based guidance is provided when appropriate, and the dose adjustments are as known, when available, in accordance to the current European Society of Cardiology guidelines.

scholarly journals A Novel Multi-Biomarker Assay for Non-Invasive Quantitative Monitoring of Kidney Injury

2019 ◽  
Vol 8 (4) ◽  
pp. 499 ◽  
Author(s):  
Drew Watson ◽  
Joshua Y. C. Yang ◽  
Reuben D. Sarwal ◽  
Tara K. Sigdel ◽  
Juliane M. Liberto ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Early Stage ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Urine Samples ◽  
Potential Contribution ◽  
Test Kit ◽  
Injury Status

The current standard of care measures for kidney function, proteinuria, and serum creatinine (SCr) are poor predictors of early-stage kidney disease. Measures that can detect chronic kidney disease in its earlier stages are needed to enable therapeutic intervention and reduce adverse outcomes of chronic kidney disease. We have developed the Kidney Injury Test (KIT) and a novel KIT Score based on the composite measurement and validation of multiple biomarkers across a unique set of 397 urine samples. The test is performed on urine samples that require no processing at the site of collection and without target sequencing or amplification. We sought to verify that the pre-defined KIT test, KIT Score, and clinical thresholds correlate with established chronic kidney disease (CKD) and may provide predictive information on early kidney injury status above and beyond proteinuria and renal function measurements alone. Statistical analyses across six DNA, protein, and metabolite markers were performed on a subset of residual spot urine samples with CKD that met assay performance quality controls from patients attending the clinical labs at the University of California, San Francisco (UCSF) as part of an ongoing IRB-approved prospective study. Inclusion criteria included selection of patients with confirmed CKD and normal healthy controls; exclusion criteria included incomplete or missing information for sample classification, logistical delays in transport/processing of urine samples or low sample volume, and acute kidney injury. Multivariate logistic regression of kidney injury status and likelihood ratio statistics were used to assess the contribution of the KIT Score for prediction of kidney injury status and stage of CKD as well as assess the potential contribution of the KIT Score for detection of early-stage CKD above and beyond traditional measures of renal function. Urine samples were processed by a proprietary immunoprobe for measuring cell-free DNA (cfDNA), methylated cfDNA, clusterin, CXCL10, total protein, and creatinine. The KIT Score and stratified KIT Score Risk Group (high versus low) had a sensitivity and specificity for detection of kidney injury status (healthy or CKD) of 97.3% (95% CI: 94.6–99.3%) and 94.1% (95% CI: 82.3–100%). In addition, in patients with normal renal function (estimated glomerular filtration rate (eGFR) ≥ 90), the KIT Score clearly identifies those with predisposing risk factors for CKD, which could not be detected by eGFR or proteinuria (p < 0.001). The KIT Score uncovers a burden of kidney injury that may yet be incompletely recognized, opening the door for earlier detection, intervention and preservation of renal function.

scholarly journals Chronic Kidney Disease, Obesity, and Hypertension: The Role of Leptin and Adiponectin

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
M. Tesauro ◽  
A. Mascali ◽  
O. Franzese ◽  
S. Cipriani ◽  
C. Cardillo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Renal Progression ◽  
Obesity Hypertension ◽  
Progression Factor

Chronic kidney disease is a major public health problem and characterized by a progressive loss in renal function over a period of months or years as defined by structural or functional abnormalities of the kidney. Several elements contribute to determine a progression of the kidney injury, inducing a worsening of renal damage and accelerating the decline of renal function: obesity and hypertension are two known factors of kidney progression. Remarkable improvements have been recently achieved in the study of the endocrine features of the adipose tissue and have been able to produce hormone-like peptides named adipokines or adipocytokines. Among these adipocytokines, which represent a link between obesity, hypertension, and chronic nephropathy, leptins and adiponectin appear to play an important role. Leptin not only is a prohypertension element (renal progression factor) through the activation sympathetic nervous, but also is able to induce prosclerotic effects directly on the kidney. In contrast, a decline of adiponectin levels has been shown to be related to a picture of hypertension: an endothelial dysfunction has been described as the main pathogenic mechanism responsible for this phenomenon.

Sign in / Sign up

Export Citation Format

Share Document