Chronic renal failure creatinine clearance

Age and cardiac faiiure are reported to be associated with reduced renal clearance of lisinopril (44). The plasma concentration and drug half-life in patients with chronic renal failure (creatinine clearance <... 

Relative contraindications include unacceptable medical risk for isolation, unmanageable coagulation disturbance, severe reparative dysfunction, acute or severe chronic renal failure (creatinine clearance below 30 ml/min), liver cirrhosis greater than Child B, leukocytes below 1500 GPT/1, thrombocytes below 50,000 GPT/1. 

In contrast to the naturally occurring Gd compounds, pharmacokinetic and pharmacological properties of the element s DOTA and DTPA chelates that are used in MRl have been studied more intensively. From a kinetic point of view, these highly hydrophilic compounds behave in an identical fashion. As expected from hydrophilic substances, the volume of distribution is small being 0.17 0.01 liters/kg in humans [13] while the plasma elimination half-life is around 20 and 90 min in rats and humans, respectively [4]. In mice 89% of the administered Gd-DOTA and Gd-DTPA doses was recovered in the urine within 1 hr [14]. In correlation with the reduced GFR in patients with chronic renal failure (median creatinine clearance 25.5 mL/min) the serum half-life of Gd-DTPA was prolonged and the renal clearance decreased. Recovery of the Gd-DTPA after administration of a 0.1 mmol/kg dose was 92 12%, whereas extrarenal elimination in these subjects accounted for less than 0.4% [15], indicating that glomerular filtration is the predominant route of elimination of the chelates. 

Recovery phase—GFR increases with clearance of waste and reduction of BUN and creatinine. May take a year to stabilize, with some residual renal insufficiency, and some patients progressing to chronic renal failure. 

Creatinine clearance < 60 mL/min/1.73 m2 (stages III-V chronic kidney disease), diabetes mellitus (with renal insufficiency), hypertension, chronic heart failure, cirrhosis, nephrosis, age >75 yr, cholesterol emboli syndrome, multiple myeloma (questionable)... 

In summary, monitoring changes in the creatinine clearance or directly measuring the GFR using markers that are not acted upon by the tubule are the best tools to detect early drug-induced renal toxicity in patients with a normal baseline creatinine concentration. Serial monitoring of the serum creatinine concentration is usually adequate in those chronic failure patients whose creatinine is already increased. The role of other endogenous compounds such as cystatin C as a way to monitor renal function is not yet known. 

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