Creatinine renal failure

O Equations to estimate creatinine clearance that incorporate a single creatinine concentration (e.g., Cockcroft-Gault) may underestimate or overestimate kidney function depending on whether acute renal failure is worsening or resolving. 

Acute renal failure (ARF) is a potentially life-threatening clinical syndrome that occurs primarily in hospitalized patients and frequently complicates the course of the critically ill. It is characterized by a rapid decrease in glomerular filtration rate (GFR) and the resultant accumulation of nitrogenous waste products (e.g., creatinine and urea nitrogen), with or without a decrease in urine output. A recent consensus statement... 

Protonated THAM (with CP or HCO, ) is excreted in the urine at a rate that is slightly higher than creatinine clearance. As such, THAM augments the buffering capacity of the blood without generating excess C02. THAM is less effective in patients with renal failure and toxicities may include hyperkalemia, hypoglycemia, and possible respiratory depression. 

Elevated serum creatinine will be present in renal failure patients... 

Obtain blood urea nitrogen and serum creatinine tests to exclude renal failure. 

The initial dose of allopurinol is based on the patient s renal function. Patients with creatinine clearances of 50 mL/minute or less should receive a starting dose of less than 300 mg/day to minimize adverse effects. The relationship between dose of allopurinol and its most severe side effects is controversial. However, the dose can be adjusted upward as needed and tolerated. It is reasonable to reduce the dose temporarily in patients who develop reversible acute renal failure. 

Nephrolithiasis/ urolithiasis/ crystalluria IDV Onset Any time after initiation of therapy, especially if 4- fluid intake Symptoms Flank pain and/or abdominal pain, dysuria, frequency pyuria, hematuria, crystallauria rarely, Tserum creatinine and acute renal failure 1. History of nephrolithiasis 2. Fhtients unable to maintain adequate fluid intake 3. High peak IDV concentration 4. tDuration of exposure Drink at least 1.5-2 L of non-caffeinated fluid per day Tfluid intake at first sign of darkened urine monitor urinalysis and serum creatinine every 3-6 months Increased hydration pain control may consider switching to alternative agent stent placement may be required... 

Gallium nitrate 100-200 mg/m2 CIV daily for 5 days 24-48 hours Do not administer if creatinine is greater than 2.5 mg/dL (221 pmol/L) may cause renal failure. 

Although determination of creatinine clearance rate is a standard clinical procedure, it is difficult to carry out mainly because accurate collection of total urine output over a 24-hour period is required. It can never be certain that this requirement has been met. Since creatinine is produced continuously in muscle and is cleared by the kidney, renal failure is characterized by elevated serum creatinine levels. The degree of elevation is directly related to the degree of renal failure—if it is assumed that the production of creatinine in the muscle mass is constant and that renal function is stable. When these assumptions are valid, there is a direct relationship between serum creatinine level and kanamycin half-life, as shown in Fig. 9. The equation of the line in Fig. 9 is... 

Fig. 9 Plot of kanamycin elimination half-life versus serum creatinine concentration in patients with varying degrees of (stable) renal failure.

The answer is d. (Hardman, p 7502) The most consistent of the toxicides of ACT inhibitors is impairment of renal function, as evidenced by proteinuria. Elevations of blood urea nitrogen (BUN) and creatinine occur frequently, especially when stenosis of the renal artery or severe heart failure exists Hyperkalemia also may occur These drugs are to be used very cautiously where prior renal failure is present and in the elderly Other toxicides include persistent dry cough, neutropenia, and angioedema. Hepatic toxicity has not been reported... 

Acute renal failure (ARF) is broadly defined as a decrease in glomerular filtration rate (GFR) occurring over hours to weeks that is associated with an accumulation of waste products, including urea and creatinine. Clinicians use a combination of the serum creatinine (Scr) value with change in either Scr or urine output (UOP) as the primary criteria for diagnosing ARF. 

ARF, acute renal failure BUN, blood urea nitrogen FEft a, fractional excretion of sodium Sa, serum creatinine RBC, red blood cell WBC, white blood cell. 

Renal Effects. The patient described by Letz et al. (1984) (see Section 2.2.3.1) who lived for 64 hours after exposure to toxic levels of 1,2-dibromoethane had acute renal failure as evidenced by severe oliguria 24 hours after exposure and abnormal clinical chemistry values (blood urea nitrogen, creatinine, and serum uric acid). Severe metabolic acidosis was present despite two hemodialysis procedures. 

Renal Effects. Acute renal failure occurred in a man who washed his hair with an unknown amount of diesel fuel (Barrientos et al. 1977). In addition, he had oliguria biopsy revealed mitosis and vacuolization in renal cells, tubular dilation, and some cellular proliferation in the glomerulus. Another man developed acute tubular renal necrosis after washing his hands with an unspecified diesel fuel over several weeks (Crisp et al. 1979). Specifically, patchy degeneration and necrosis of the proximal and distal tubular epithelium with preservation of the basement membranes were noted. Also, increased blood urea nitrogen and serum creatinine levels were noted in this individual. Effects resulting from inhalation versus dermal exposure could not be distinguished in these cases. 

Renal function impairment No changes were observed in the pharmacokinetics of dipyridamole or its glucuronide metabolite with creatinine clearances ranging from approximately 15 mL/min to more than 100 mL/min if data were corrected for differences in age. Avoid aspirin in patients with severe renal failure (glomerular filtration rate less than 10 mL/min). 

In hemodialysis patients or in case of acute renal failure (Ccr less than 15 mL/min or serum creatinine more than 6 mg/dL), avoid or stop infusion of lepirudin. Consider additional IV bolus doses of 0.1 mg/kg every other day only if the aPTT ratio falls below the lower therapeutic limit of 1.5. ... 

Renal function impairment Patients with type 2 diabetes who have severe renal function impairment should initiate repaglinide with the 0.5 mg dose. Studies were not conducted in patients with creatinine clearances lower than 20 mL/min or patients with renal failure requiring hemodialysis. 

Renal function impairment WnWe caution should be used in patients with severe renal failure, therapeutic concentrations of nalidixic acid in the urine, without increased toxicity caused by drug accumulation in the blood, have been observed in patients on full dosage with creatinine clearances (Ccr) as low as 2 to 8 mL/min. Special risk Use nalidixic acid with caution in patients with epilepsy, liver disease, or severe cerebral arteriosclerosis. 

Renai effects Elevations in serum urea nitrogen (BUN) and creatinine, and isolated cases of significant renal dysfunction or acute renal failure have been reported in patients who received micafungin. 

Severe - Leukopenia (less than 1000/mm ) 2.8% hypoglycemia (less than 25 mg/dL) 2.4% thrombocytopenia (less than 20,000/mm ) 1.7% hypotension (less than 60 mm Hg systolic) 0.9% acute renal failure (serum creatinine greater than 6 mg/dL) 0.5% hypocalcemia (0.2%) Stevens-Johnson syndrome and ventricular tachycardia (0.2%) fatalities caused by severe hypotension, hypoglycemia, and cardiac arrhythmias. 

Renal - Methotrexate may cause renal damage that may lead to acute renal failure. Close attention to renal function including adequate hydration, urine alkalinization and measurement of serum methotrexate and creatinine levels are essential for safe administration. 

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. 

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