Renal failure serum creatinine

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. 

Fig. 17. Comparison of contrast enhancement 24h afterthe administration of contrast medium between exercise-induced acute renal failure (ALPE) and myoglobinuric acute renal failure (serum creatinine 3mg/dl). The patient with ALPE showed patchy wedge-shaped contrast enhancement, and the patient with myoglobinuric acute renal failure showed diffuse contrast enhancement...

The apparent volume of distribution of naproxen averaged abut 8.3 L in healthy adults and about 11.9 L in patients with severe renal failure (serum creatinine 5.4-12.5 mg/dl)(2). In healthy adults, plasma half-life of naproxen reporfly ranges from 10-20 hours. 

Contraindications for the TACE are poor performance status (Karnofsky status <50%), nutritional impairment, neoplastic ascites, high serum bilirubin level (> 3 mg%), poor hepatic synthesis (serum albumin < 2.0 mg/dl) and renal failure (serum creatinine > 2 mg%). There should be an adequate amount of residual uninvolved liver tissue. A tumor burden of more than 50%-75% resulting in an inadequate liver function is regarded as a contraindication for performing TACE (Therasse et al. 1993 Gates et al. 1999). Likewise florid infections or myelosuppres-sion (white blood cell count < 2000/ml, elementary bodies < 100,000/pl) are classified as contraindications for TACE. 

The use of prophylactic hemodialysis, in most cases starting more than 20 minutes after injection of a contrast agent, has been investigated in 113 patients with renal insufficiency (serum creatinine concentration over 200 pmol/l) (186). Hemodialysis did not reduce the incidence of contrast nephrotoxicity. This failure could have been related to the rapid onset of renal injury after the administration of the contrast agent. 

Acute decreases in renal function and hyperkalemia usually resolve over several days after ACEl or ARB therapy is discontinued. Occasional patients will require management of severe hyperkalemia, usually with sodium polystyrene sulfate (see Chap. 50). ACEl or ARB therapy may frequently be reinitiated, particularly for patients with congestive heart failure, after intravascular volume depletion has been corrected or the diuretic doses reduced. The development of mild renal insufficiency (serum creatinine concentration of 2 to 3 mg/dL) may be an acceptable trade-off for hemodynamic improvement in certain patients with severe congestive heart failure or renovascular disease not amenable to invasive management. Congestive heart failure patients with greater renal insufficiency may be best treated by substitution of hydralazine and nitrates for afterload reduction. 

In contrast to the naturally occurring Gd compounds, pharmacokinetic and pharmacological properties of the element s DOTA and DTPA chelates that are used in MRl have been studied more intensively. From a kinetic point of view, these highly hydrophilic compounds behave in an identical fashion. As expected from hydrophilic substances, the volume of distribution is small being 0.17 0.01 liters/kg in humans [13] while the plasma elimination half-life is around 20 and 90 min in rats and humans, respectively [4]. In mice 89% of the administered Gd-DOTA and Gd-DTPA doses was recovered in the urine within 1 hr [14]. In correlation with the reduced GFR in patients with chronic renal failure (median creatinine clearance 25.5 mL/min) the serum half-life of Gd-DTPA was prolonged and the renal clearance decreased. Recovery of the Gd-DTPA after administration of a 0.1 mmol/kg dose was 92 12%, whereas extrarenal elimination in these subjects accounted for less than 0.4% [15], indicating that glomerular filtration is the predominant route of elimination of the chelates. 

Renal increased serum creatinine, uremia, acute renal failure... 

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

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

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.

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. 

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. ... 

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. 

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. 

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