Kidneys, renal function monitoring

While still preliminary, this study demonstrates the feasibility of evaluating the renal status in real-time by optical modality. This continuous renal function monitoring by the optical modality represents a new and minimally invasive method to detect kidney malfunctions. In addition to using relatively harmless radiation, the simplicity and portability of the equipment make this approach compatible for use in ambulatory and critical care. However, further studies... 

RISK FOR INEFFECTIVE TISSUE PERFUSION RENAL When the patient is taking a drag tiiat is potentially toxic to die kidneys, die nurse must carefully monitor fluid intake and output. In some instances, die nurse may need to perform hourly measurements of die urinary output. Periodic laboratory tests are usually ordered to monitor the patient s response to therapy and to detect toxic drag reactions. Seram creatinine levels and BUN levels are checked frequentiy during the course of therapy to monitor kidney function. If the BUN exceeds 40 mg dL or if the serum creatinine level exceeds 3 mg cIL, the primary health care provider may discontinue the drug therapy or reduce the dosage until renal function improves. 

MTX is potentially toxic. Therefore, the nurse observes closely for development of adverse reactions, such as thrombocytopenia (see Nursing Alert in Gold Compounds section) and leukopenia (see discussion of adverse reactions associated with hydroxychloroquine). Hematology, liver, and renal function studies are monitored every 1 to 3 months with MTX therapy. The primary care provider is notified of abnormal hematology, liver function, or kidney function finding. The nurse immediately brings all adverse reactions or suspected adverse reactions to the attention of the primary health care provider. 

Saline laxatives containing magnesium, potassium, or phosphates should be used cautiously in persons with reduced kidney function. Monitor appropriate serum electrolyte concentrations in patients with unstable renal function evidenced by changing serum creatinine or creatinine clearance. 

The most common side effects include somnolence, dizziness, anorexia, headache, nausea, word-finding difficulties, oligohidrosis, modest weight loss, and irritability. Symptomatic kidney stones may occur in 2.6% of patients. Hypersensitivity reactions may occur in 0.02% of patients, and it should be used with caution if at all in patients with a history of allergy to sulfonamides. Monitoring of renal function may be advisable in some patients. 

Renal function impairment Because diflunisal is eliminated primarily by the kidneys, monitor patients with significant renal impairment use a lower daily dosage. Pregnancy Category C. 

Eideriy This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, take care in dose selection it may be useful to monitor renal function. 

Elderly Clinical studies of nalidixic acid did not include sufficient numbers of subjects 65 and years of age and older to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. Observe caution when using nalidixic acid in elderly patients. This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be higher in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, take care in dose selection it also may be useful to monitor renal function. 

Monitor renal function carefully patients with renal impairment and/or nitrogen retention should receive reduced doses. Do not exceed peak serum concentrations of 20 to 25 mcg/mL in individuals with kidney damage. 

Elderly Patients at least 65 years of age are more likely to develop systolic hypertension on therapy, and more likely to show serum creatinine rises greater than or equal to 50% above the baseline after 3 to 4 months of therapy. Monitor elderly patients with particular care, because decreases in renal function also occur with age. If patients are not properly monitored and dosages are not properly adjusted, cyclosporine therapy can cause structural kidney damage and persistent renal dysfunction. 

Closely monitor for serious reactions, especially in patients taking other drugs that are excreted by the kidneys or are known to affect renal function... 

Concomitant use with sympathomimetic drugs, p-adrenoceptor antagonists, calcium channel-entry blockers and other cardioactive drugs may result in bradyarrhythmias, bigemini, or tachyarrhythmias. Cardiac rhythm should be closely monitored and drug dosages carefully adjusted. Digoxin is mainly excreted by the kidneys and plasma levels should be closely monitored in patients with acute renal failure and in those whose renal function is compromised. 

Gastrointestinal complaints (eg, nausea, diarrhea, vomiting, flatulence) are the most common adverse effects but rarely require discontinuation of therapy. Other potential adverse effects include headache and asthenia. Tenofbvir-associated proximal renal tubulopathy causes excessive renal phosphate and calcium losses and 1-hydroxylation defects of vitamin D, and preclinical studies in several animal species have demonstrated bone toxicity (eg, osteomalacia). Monitoring of bone mineral density should be considered with long-term use in those with risk factors for or with known osteoporosis, as well as in children. Reduction of renal function over time, as well as cases of acute renal failure and Fanconi s syndrome, have been reported in patients receiving tenofovir alone or in combination with emtricitabine. For this reason, tenofovir should be used with caution in patients at risk for renal dysfunction. Tenofovir may compete with other drugs that are actively secreted by the kidneys, such as cidofovir, acyclovir, and ganciclovir. 

Renal dysfunction Poor kidney function (10% or less of normal) causes accumulation of antibiotics that are ordinarily eliminated by this route. This may lead to serious adverse effects unless controlled by adjusting the dose or the dosage schedule of the antibiotic. Although serum creatinine levels are sometimes used as an index of renal function for adjustment of drug regimens, direct monitoring of serum levels of some antibiotics is preferred... 

Serum creatinine and BUN, the most common indicators of renal function used in both clinical and preclinical safety laboratory panels, are relatively insensitive markers of injury, particularly for the renal tubules. Urinary measurements of alanine aminopeptidase and A-acetyl-beta-D-glucosaminidase and kidney injury molecule-1 (KIM-1) can provide much more sensitivity when nephrotoxicity is a potential safety concern [28,29], These are also suitable for safety monitoring in early-phase human trials if preclinical studies validate such use to monitor product nephrotoxicity. 

Kidney Currently, there are no kidney-specific leakage enzymes assayed in serum. Renal function is evaluated by assaying serum levels of nitrogenous wastes—blood urea nitrogen (BUN) and creatinine—and monitoring protein levels in the urine (indicator of glomerular damage). 

METHOTREXATE PROCARBAZINE t risk of renal impairment if methotrexate infusion is given within 48 hours of procarbazine administration. Also t risk of methotrexate toxicity, particularly to the kidneys Procarbazine has a transient effect on the kidneys, and this will delay the renal elimination of methotrexate Do not start methotrexate infusion less than 72 hours after the last dose of procarbazine. Hydrate patients aggressively (plenty of oral fluids or intravenous fluids), alkalinize the urine to pH>7 and closely monitor renal function, e.g. blood urea and creatinine, before and after methotrexate infusion until methotrexate blood levels are <0.05 xmol/L... 

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS GANCICLOVIRAfALGANCIC LOVIR 1. T adverse effects with tenofovir, zidovudine and possibly didanosine, lamivudine and zalcitabine 2. Possibly 1 efficacy of ganciclovir 1. Uncertain possibly additive toxicity. Lamivudine may compete for active tubular secretion in the kidneys 2. Uncertain L bioavailability 1. Avoid if possible otherwise monitor FBC and renal function weekly. It has been suggested that the dose of zidovudine should be halved from 600 mg to 300 mg daily. Monitor for peripheral neuropathy, particularly with zalcitabine 2. Uncertain clinical significance if in doubt, consider alternative cytomegalovirus prophylaxis... 

Monitor electrolytes and renal function tests in symptomatic patients. Administer intravenous fluids to maintain urine output and to protect the kidneys from myoglobinuria. The prognosis is good if animals do not develop rhabdomyolysis or secondary infection. No chronic problems are expected from BZ itself (Holstege, 2006). 

Uses. Ciclosporin is used to prevent and treat rejection of organ transplants (kidney, liver, heart-lung) and bone marrow transplants. It may be given orally or i.v. In the context of transplantation, administration continues indefinitely and must be carefully monitored, including measurement of plasma concentration and renal function. It is generally stopped after 6 months in patients who have received a bone marrow transplant unless there is ongoing chronic graft-versus-host disease. 

Although potassium supplementation is necessary in some individuals being treated with a potassium-depleting diuretic, the initiation of therapy with such a diuretic must not be viewed as a mandate to provide potassium supplementation. This decision should be based on a consideration of the individual patient s situation and the appropriate parameters should be periodically monitored. It must be recognized that dangers exist if hyperkalemia occurs as a result of excessive supplementation. Although the kidneys are usually able to excrete excessive amounts of potassium rapidly, hyperkalemia may develop, especially in patients with diminished renal function. 

Isolated perfused kidney Morphologically identical to kidney in vivo. Can monitor renal function. Short term use. In the process of degeneration. 

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