Creatinine clearance measured

Additive renal toxic effects may occur with immunosuppressants (e.g. azathioprine, ciclosporin, tacrolimus), ACE inhibitors, penicillamine, irinotecan and aminoglycoside antibiotics. A deterioration of renal function may even occur after the topical use of NSAIDs. Guidelines are variable for the use of NSAIDs with differing degrees of renal function, as assessed by creatinine clearance measurements. 

Urea is filtered at the glomerulus and about 40% is reabsorbed by passive diffusion from the renal tubules. Estimation of urea clearance therefore represents about 60% of the glomerular filtration rate. In most laboratories, however, creatinine clearance measurement is preferred to urea clearance. 

Equation to adjust measured phenytoin levels in the setting of creatinine clearance <10 mL/min +/- hypoalbuminemia... 

Obtain a baseline serum creatinine measurement. Calculate the estimated creatinine clearance and adjust the dose of H2RAs and sucralfate according to package insert recommendations. 

Direct measurement of creatinine clearance (CrCl) requires collection of urine over an extended time interval (usually 24 hours) with measurement of urine volume, urine creatinine concentration, and serum creatinine concentration (Table 22-1). Because kidney function can fluctuate significantly during ARF, this method may underestimate or overestimate kidney function depending on whether ARF is worsening or resolving. 

Formula for Estimating Creatinine Clearance from a Measured Urine Collection... 

Blood lead levels, urinary lead levels, serum creatinine, blood urea nitrogen (BUN), creatinine clearance (CCT), and NAG were measured in 158 male and 51 female workers in a lead battery factory or a lead smelting plant in Japan (Ong et al. 1987). Controls consisted of 30 professional and laboratory staff members with no history of renal disease or lead exposure. The length of exposure to lead averaged 10.8 8.0 years with a range of 1-36 years. Exposure levels were not available, but indicators of lead body burden in the exposed workers were PbB level = 3.0-80.0 pg/dL and urinary lead level =... 

Renal function can be grossly assessed by hourly measurements of urine output, but estimation of creatinine clearance based on isolated serum creatinine values in critically ill patients may yield erroneous results. Decreased renal perfusion and aldosterone release result in sodium retention and, thus, low urinary sodium (<30 mEq/L). 

Calculate measured creatinine clearance Calculate fractional excretion of sodium Plans for renal replacement... 

Serum creatinine is not a good measure of renal function in elderly because muscle mass is reduced and the production of creatinine is thus reduced. Estimation of GFR based on serum creatinine is therefore not accurate enough in the elderly (Baracskay et al. 1997). Creatinine clearance should be used instead. Another possibility is measurement of cystatin C in plasma. The rate of production of cystatin C is relatively constant so it seems to be a more reliable estimation of GFR also in older adults. 

Adverse reactions to gold, especially dermatitis, can occur at plasma gold levels as low as 1 /ug/ml but impaired creatinine clearance, which is indicative of severe kidney damage, is rarely seen at plasma gold levels less than 4 [ig/ml (L14). The clinical value of plasma gold measurements must still be considered unsettled, despite the optimism of many investigators. 

As many tables of drug doses in renal failure given in reference books are related to the creatinine clearance, this gives a practical and useful measure to be used in the hospital or clinic. 

An instructive example is the physiological variable serum creatinine. Creatinine is an endogenous metabolite formed from, and thus reflecting, muscle mass. Total body muscle mass is sufficiently constant to render measurement of serum creatinine useful for assessing actual renal function. The serum value of creatinine (R) is namely dependent on the continuous (zero-order) input of creatinine into the blood (A in) and its renal elimination rate, which is a first-order rate process (A out x ) In case of an extensive muscle breakdown, kin will temporarily increase. It may also be permanently low, for example in old age when muscle mass is reduced. Likewise, creatinine clearance may decrease for various reasons, described by a decrease in A out- An increase in creatinine clearance may occur as well, for example following recovery from renal disease. According to pharmacodynamic indirect response models. 

It is well known that both glomerular and tubular renal functions decline with age in at least one third of individuals. As a result there is greater variation in renal function in older subjects. Glomerular filtration rate can be predicted by creatinine clearance, which can be estimated based on measured serum creatinine (Sercr) concentration. One such formula is the Cochrane and Gault formula in which... 

The effect of age on the renal elimination of some drugs is shown in Table 2. In general, the dose can be guided by the estimated or measured creatinine clearance. This should be performed in particular... 

The good bioavailability of orally administered ciprofloxacin obviates the need for the more expensive intravenous formulation. I.v. ciprofloxacin is only given to patients who have severe sepsis or severe nausea and vomiting. Ciprofloxacin s elimination is 50% hepatic and 50% renal. Therefore, dose reduction is recommended only in case creatinine clearance drops to < 10 ml/min. Prevention of food-borne disease requires efforts at many levels. Monitoring safety of food processing, vector control, surveillance of outbreaks, education on personal hygiene and improving sanitation and access to safe water supplies are all necessary measures to reduce the incidence of GTI. 

Maintain normal sinus rhythm after conversion from atrial fibrillation or flutter PO Individualized using a seven-step dosing algorithm dependent upon calculated creatinine clearance and QT interval measurements. 

Drugs cleared by the renal route often require adjustment of clearance in proportion to renal function. This can be conveniently estimated from the creatinine clearance, calculated from a single serum creatinine measurement and the predicted creatinine production rate. 

Inhibitors of the renal cation secretion mechanism, eg, cimetidine, prolong the half-life of dofetilide. Since the QT-prolonging effects and risks of ventricular proarrhythmia are directly related to plasma concentration, dofetilide dosage must be based on the estimated creatinine clearance. Treatment with dofetilide should be initiated in hospital after baseline measurement of the rate-corrected QT interval (QTC) and serum electrolytes. A baseline QTC of > 450 ms (500 ms in the presence of an intraventricular conduction delay), bradycardia of < 50 bpm and hypokalemia are relative contraindications to its use. 

For women, the result should be multiplied by 0.85 (because of reduced muscle mass). It must be emphasized that this estimate is, at best, a population estimate and may not apply to a particular patient. If the patient has normal renal function (up to one third of elderly patients), a dose corrected on the basis of this estimate will be too low—but a low dose is initially desirable if one is uncertain of the renal function in any patient. If a precise measure is needed, a standard 12- or 24-hour creatinine clearance determination should be obtained. As indicated above, nutritional changes alter pharmacokinetic parameters. A patient who is severely dehydrated (not uncommon in patients with stroke or other motor impairment) may have an additional marked reduction in renal drug clearance that is completely reversible by rehydration. 

Masuo et al. [19] measured renal function (creatinine, BUN, creatinine clearance) and plasma norepinephrine levels over a 5-year period in nonobese, normotensive men with normal renal function. Subjects who had a significant deterioration of renal function (>10% increases from baseline of creatinine and BUN or decrease in creatinine clearance) over a 5-year period had higher plasma norepinephrine at the entry period and greater increases in plasma norepinephrine over 5 years (Figure 2). In this study, subjects who had significant changes in body weight or blood pressure were excluded. 

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