Creatinine clearance significance

U.S. Boston, MA, NAS (N = 709 total, 670 for full assessment) Pb exposure indexed 1991 —1995 markers = PbB, tibial Pb, patella Pb. PbB mean = 6.2, tibial Pb = 22 (j.g/g mineral, patella Pb = 32 pg/g mineral Serum creatinine, estimated creatinine clearance Significant inverse association between patella Pb and creatinine clearance Wu et al. (2003)... 

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. 

BA, bioavailability CL, total body clearance CrCI, creatinine clearance CYP450, cytochrome P-450 ER, extended-release IR, immediate-release LA, long-acting PPI, proton pump inhibitor Sign., significantly SR, sustained-release TD, transdermal. 

BA, bioavailability BP, blood pressure CEE, conjugated equine estrogens CrCI, creatinine clearance CYP450, cytochrome P-450 DR, delayed-release Ml, myocardial infarction PV, per vagina Sign., significantly TD, transdermal TE, thromboembolism. 

Methotrexate is an antimetabolite drug that is excreted primarily by the kidney. It is contraindicated in significant renal impairment and in hepatic impairment. It is nephrotoxic and accumulation may occur in renal impairment. Dose should be reduced in renal impairment that is not severe and drug should be avoided if creatinine clearance is less than 20 mL/minute. 

Anuria, oliguria, or significant impairment of renal function (creatinine clearance [Ccr] less than 60 mL/min or clinically significant elevated serum creatinine) hypersensitivity to nitrofurantoin. 

Contraindications Autoimmune hepatitis, creatinine clearance less than 50 ml/min, hemoglobinopathies, hepatic decompensation, hypersensitivity to ribavirin products, pregnancy, significant or unstable cardiac disease... 

Pharmacokinetics Poorly bound to plasma proteins unbound fraction in plasma 35%. Limited metabolism. Primarily eliminated in the urine (65%) and, to a lesser amount, in the feces. Removed by hemodialysis. Half-life 2 hr. Clearance is significantly decreased in severe renal impairment (creatinine clearance less than 30 ml/min). 

Among patients with advanced kidney disease (mean creatinine clearance, 26 mL/min), an increase in SCr levels of at least 25% was significantly less common in patients randomly assigned to prophylactic hemofiltration before and after the administration of CM than in those assigned to receive fluid alone (5% vs. 50%, p < 0.001) (75), In-hospital death was also significantly less frequent in the hemofiltration group, However, the SCr level is directly altered by the intervention, and the relationship between the intervention and the reduced mortality rate is unclear. Thus, the role of hemodialysis in patients at high risk for CIN remains uncertain. 

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. 

Carvounis CP, Nisar S, Guro-Razuman S (2002) Significance of the fractional excretion of urea in the differential diagnosis of acute renal failure. Kidney Int 62 2223-2229 Dunn SR, Qi Z, Bottinger EP et al. (2004) Utility of endogenous creatinine clearance as a measure of renal function in mice. Kidney Int 65 1959-1967... 

Serum creatinine increases up to 500 mM/L after 12 months, whereas creatinine clearance decreases. Significantly increased urine volumes are accompanied by decreased urine specific gravity indicating a decreased concentrating ability. Proteinuria is significantly increased. Terminal uremia occurs after 14—15 months. 

In a comparison of patients taking long-term lithium (n = 10) or short-term lithium (n = 9) and bipolar patients not taking lithium (n = 10), there was significantly lower creatinine clearance and renal concentrating ability in the long-term group (372). 

The main side effect associated with oral acyclovir, valacyclovir, and femciclovir is intestinal disturbance such as nausea and vomiting. Acyclovir is available in an 800-mg tablet that does not contain lactose therefore it is less likely to cause lactose-related diarrhea. Lower dosages are recommended for treatment of elderly patients with impaired creatinine clearance. Perhaps the most significant factor in fevor of antivirals is that they minimize the common complications of the disease, including dendriform keratopathy, stromal keratitis, and anterior uveitis. 

The safety and efficacy of ABCD have been stndied in 220 bone marrow transplant recipients enrolled in the same five phase I or phase II stndies (23). The median dose in this population was 4 (range 0.4—8.0) mg/kg, and the median duration of treatment was 16 (range 1-409) days. Overall, 37 (19%) of the patients had nephrotoxicity, defined as a doubling of serum creatinine from baseline, an increase of 88 pmol/l from baseline, or at least a 50% fall in calculated creatinine clearance. There were no significant changes in hepatic transaminases, alkaline phosphatase, or total bilirubin. Fever and chills were reported by 12 and 11% of patients respectively. Other acute, severe, infusion-related adverse events were hypoxia (4.1%), hypertension (2.7%), and hypotension (2.7%). 

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