Renal failure index

A 43-year-old woman with rheumatoid arthritis developed dizziness having taken celecoxib 200 mg/day for 2 weeks. At the start of treatment she had normal renal function (104). Her serum creatinine was 670 pmol/l (7.4 mg/dl) and blood urea nitrogen 30 mmol/1 (90 mg/dl). Creatinine clearance was 16 ml/minute. Urinalysis was normal and casts were not present. Urinary chemical analysis showed a sodium concentration of 18 mmol/1, a fractional excretion of sodium of 0.3, and a renal failure index of 0.493, consistent with prerenal acute renal insufficiency. Celecoxib was withdrawn. Although her renal function then improved, her serum creatinine was still abnormal (4.7 mg/dl) 1 month later. 

If a p-lactam is uniquely advantageous for a patient, a carefully controlled rechallenge can be considered to more precisely identify a cause-effect relationship. When p-lactams are used in neonates, accurate determination of the dosage is required, especially for compounds with low therapeutic index and in patients with renal failure. 

Early in the development of cisplatin, more than 70% of patients developed acute renal failure that appeared to be cisplatin dose-related [34, 35]. Despite aggressive hydration, especially with NaCl solutions, which are routinely apphed in the clinical setting to prevent nephrotoxicity [36], renal failure still occurs [37,38,39]. Therefore several attempts have been made to reduce nephrotoxicity by either co administration of other compounds, alternate method of administration, or by developing analogues with an improved therapeutic index. 

Because fluoroquinolones have a wide therapeutic index and dose-dependent toxicity, routine drug monitoring is not indicated. Monitoring fluoroquinolone concentration is indicated in renal failure, which wfll cause fluoroquinolones to accumulate. Optimal response occurs when serum concentration exceeds 1.5 Llg/mL. Activity is maintained as long as the trough concentration is >0.2flg/mL. Coadministration with antacids, ferrous sulfate, food, or sucralfate reduces absorption by 30% to 60%. Co-administration with morphine reduces absorption by >50%. 

Fig. 13. Plasma calcium and Phosphate Excretion Index in 34 cases of primary hyperparathyroidism (r = 0.65 p <0.01). (Circled case in renal failure and omitted from calculation.) [Including data of Reiss (R4) and Reynolds (R5).]...

Stenvinkel, P, Hohnberg, 1, Heimburger, O and Diczfalusy, U (1998) A study of plasmalogen as an index of oxidative stress in patients with chronic renal failure. Evidence of increased oxidative stress in malnourished patients. Nephrol Dial Transplant, 13, 2594—2600. 

A high index of suspicion for RMP-associated acute renal failure should be maintained in patients with pulmonary TB who develop a progressive deterioration of renal function during treatment with RMP. 

Other changes such as disturbance of flow pattern, increase of resistive index or variations of cortico-medullary differentiation are influenced by renal function, cardiac situation and medication. Only rarely US-guided renal biopsy is performed. Additional imaging is not necessary except for extra-renal queries related to chronic renal failure and ESRD and for ore-transplantation workup. 

Luciano R, Gallini F, Romagnoli C et al (1998) Doppler evaluation of renal blood flow velocity as a predictive index of acute renal failure in perinatal asphyxia. Eur J Pediatr... 

A 42-year-old woman suffered an acute anterior myocardial infarction, initially associated with pulmonary edema. After hemodjmamic stabilization she was given lisinopril 10 mg oraUy. Two hours later she developed circulatory failure in conjunction with acute renal insufficiency. Right heart catheterization showed markedly reduced systemic vascular resistance but a normal cardiac index. After the usual causes of cardiogenic shock had been ruled out, repeated fluid challenges and intravenous noradrenaline failed to improve her hemodynamic status. She was therefore given angiotensin II intravenously (5-7.5 pg/minute), which immediately and markedly raised the systematic vascular... 

Narrow therapeutic index when the ratio between therapeutic and toxic doses is small Organ deficiency in the case of reduced renal excretion, decreased hepatic metabolism, heart failure leading to decreased clearance... 

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