Impaired kidney function

In the kidney, ANG II reduces renal blood flow and constricts preferentially the efferent arteriole of the glomerulus with the result of increased glomerular filtration pressure. ANG II further enhances renal sodium and water reabsorption at the proximal tubulus. ACE inhibitors thus increase renal blood flow and decrease sodium and water retention. Furthermore, ACE inhibitors are nephroprotective, delaying the progression of glomerulosclerosis. This also appears to be a result of reduced ANG II levels and is at least partially independent from pressure reduction. On the other hand, ACE inhibitors decrease glomerular filtration pressure due to the lack of ANG II-mediated constriction of the efferent arterioles. Thus, one important undesired effect of ACE inhibitors is impaired glomerular filtration rate and impaired kidney function. 

The antihistamines are used cautiously in patients with bronchial asthma, cardiovascular disease, narrow-angle glaucoma, symptomatic prostatic hypertrophy, hypertension, impaired kidney function, peptic ulcer, urinary... 

Uremia A condition that results from accumulation of metabolic waste products and endogenous toxins in the body resulting from impaired kidney function. Symptoms of uremia include nausea, vomiting, weakness, loss of appetite, and mental confusion. 

Nitroprusside is the agent of choice for minute- to-minute control in most cases. It is usually given as a continuous IV infusion at a rate of 0.25 to 10 mcg/kg/min. Its onset of hypotensive action is immediate and disappears within 1 to 2 minutes of discontinuation. When the infusion must be continued longer than 72 hours, serum thiocyanate levels should be measured, and the infusion should be discontinued if the level exceeds 12 mg/dL. The risk of thiocyanate toxicity is increased in patients with impaired kidney function. Other adverse effects include nausea, vomiting, muscle twitching, and sweating. 

Several occupational studies reveal that cadmium can slowly accumulate in kidneys and impair kidney function. These studies involved exposure by... 

Inhalation of appreciable amounts of cresol vapor is unlikely under normal conditions because of the low vapor pressure however, hazardous concentrations may be generated at elevated temperatures. Seven workers exposed to cresol vapor at unspecified concentrations for 1.5-3 years had headaches, which were frequently accompanied by nausea and vomiting. Four of the workers also had elevated blood pressure, signs of impaired kidney function, blood calcium imbalance, and marked tremors. Eight of ten subjects exposed to 1.4 ppm o-cresol vapor experienced upper respiratory tract irritation. ... 

A 57-year-old woman, who had taken metformin 500 mg bd for 15 years, took indometacin 50 mg qds for 2 months. She developed oliguria and acidosis (pH 6.82, serum lactate 21 mmol/1, creatinine 480 pmol/l). After stopping metformin and indometacin she improved and left hospital with stable impaired kidney function. 

The authors reported that two other cases of metformin-associated lactic acidosis with concurrent NSAID therapy have been reported to the Committee on Safety of Medicines in the UK. Indometacin can impair kidney function and may have done so in this case. Phenformin can cause tubular damage and oliguria in animals (145) and so it is conceivable that metformin-induced renal damage may also have contributed. 

The first goal of rehabilitation from any eating disorder is to stabilize both weight and self-destructive behavior such as diuretic abuse and binge eating. Patients with anorexia may be severely malnourished, and could have additional related health problems such as impaired kidney function and dehydration that need immediate medical attention. They may also require intravenous feeding. 

Renal tubular acidosis and other renal injury resulting in nitrogen retention have been attributed to the administration of outdated tetracycline preparations. Tetracyclines given along with diuretics may produce nitrogen retention. Tetracyclines other than doxycycline may accumulate to toxic levels in patients with impaired kidney function. 

The kidney and bladder are very important in toxicology because they are the main route of elimination of hydrophilic toxicant metabolites and because damage to them in the form of impaired kidney function or bladder cancer is one of the major adverse effects of toxicants. The kidney plays a key role in maintaining body homeostasis. The basic unit of the kidney, through which the organ performs its crucial blood filtration action, is the nephron. As the main organ through which fluid is lost from the body, it is vital in the maintenance of extracellular fluid volume. It acts to maintain... 

Many symptoms of aluminum toxicity are similar to those of Alzheimer s disease and osteoporosis. This suggests that long-term accumulation of aluminum in the brain may contribute to the development of Alzheimer s disease. In addition, an unidentified protein not found in normal brain tissue has been discovered in the brain tissue of Alzheimer s patients. Because aluminum is excreted by the kidneys, toxic amounts of aluminum also may impair kidney function. People who worked in aluminum smelting plants for long periods have been found to experience dizziness, impaired coordination, and losses of balance and energy. Accumulation of aluminum in the brain was cited as a possible cause for these symptoms as well. This has caused concern, especially as it relates to neurotoxicology (Alzheimer s disease).19-21... 

Pharmacokinetics Topotecan is given by IV infusion over 30 minutes for five consecutive days. Responses may not be seen for three weeks. Hydrolysis of the lactone ring destroys the drug s activity. About 30 percent of the drug and its metabolites is eliminated in the urine hence, the dose may have to be modified with impaired kidney function. 

Gabutti L, Gugger M, Marti HP. Eingeschrankte Nieren-funktion bei Lithium-therapie. [Impaired kidney function... 

ACE inhibitors can cause hyperkalemia because they inhibit the release of aldosterone. The effect is usually not significant in patients with normal renal function. However, in patients with impaired kidney function and/or in patients taking potassium supplements (including salt substitutes) or potassium-sparing diuretics, and especially aldosterone antagonists, hyperkalemia can occur. In two cases, hypoaldosteronism with diabetes was implicated (53,54). 

Although there is no evidence that these abnormalities progress to frank bone marrow aplasia, continuation of chloramphenicol after the appearance of early toxicity is thought to be hazardous. Pre-existing liver damage (for example due to infectious hepatitis or alcoholism) and impaired kidney function can lead to reduced elimination of chloramphenicol and its metabolites, thereby aggravating marrow toxicity. As a rule, this is not the irreversible type. 

Impaired kidney function, with reduced clearance of chloramphenicol, may be a risk factor for toxicity. 

Of 207 patients with ischemic stroke, stages III or IV, treated with an intravenous infusion of dextran 40 over 4 days, 9 (4.3%) developed acute renal insufficiency attributable to the dextran. Oliguria occurred after a mean time of 4 (range 3-6) days. The incidence of dextran-induced renal insufficiency was higher in patients with pre-existing impaired kidney function. The high risk of death in the patients who developed renal insufficiency was due to non-renal complications, notably pneumonia and pulmonary embolism (10). 

A 30-year-old woman with renal insufficiency on hemodialysis three times a week suffered no significant toxicity after ingesting 600 mg tds of gabapentin for 3 weeks, a large dose in view of her impaired kidney function (43). The blood gabapentin concentration was 496 pmol/1. 

In patients with severe renal impairment, kidney function can be effectively substituted by using an... 

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