Renal function, assessment

Zoledronate has been associated with renal toxicity, deterioration of renal function, and potential renal failure. Thus, the infusion should be given over at least 15 minutes, and the dose should be 4 mg. Patients who receive zoledronate should have standard laboratory and clinical parameters of renal function assessed prior to treatment and periodically after treatment to monitor for deterioration in renal function. 

INEFFECTIVE TISSUE PERFUSION RENAL The patient taking an aminoglycoside is at risk for nephrotoxicity. The nurse measures and records the intake and output and notifies the primary health care provider if the output is less than 750 ml/day. It is important to keep a record of the fluid intake and output as well as a daily weight to assess hydration and renal function. The nurse encourages fluid intake to 2000 ml/day (if the patient s condition permits). Any changes in the intake and output ratio or in the appearance of the urine may indicate nephrotoxicity. The nurse reports these types of changes to the primary health care provider promptly. The primary health care provider may order daily laboratory tests (ie, serum creatinine and blood urea nitrogen [BUN]) to monitor renal function. The nurse reports any elevation in the creatinine or BUN level to tiie primary health care provider because an elevation may indicate renal dysfunction. 

The nurse obtains the vital signs at die time of the initial assessment to provide baseline data. The primary healtii care provider may order many laboratory and diagnostic tests, such as an electroencephalogram, computed tomographic scan, complete blood count, and hepatic and renal function tests to confirm the diagnosis and identify a possible cause of the seizure disorder, as well as to provide a baseline during therapy with anticonvulsants. 

Laboratory tests can help in assessing the effects of inhalant use. Laboratory tests that measure hepatic function, renal function, and hematopoietic... 

Provide a plan to assess the effectiveness and safety of therapy. Follow-up in 2 to 4 weeks if the medication regimen has changed, otherwise semi-annual or annual clinic visits to assess blood pressure, electrolyte balance, and renal function should occur. 

There is a paucity of clinical trial evidence comparing the benefit of diuretics to other therapies for symptom relief or long-term outcomes. Additionally, excessive preload reduction can lead to a decrease in CO resulting in reflex increase in sympathetic activation, renin release, and the expected consequences of vasoconstriction, tachycardia, and increased myocardial oxygen demand. Careful use of diuretics is recommended to avoid overdiuresis. Monitor serum electrolytes such as potassium, sodium, and magnesium frequently to identify and correct imbalances. Monitor serum creatinine and blood urea nitrogen daily at a minimum to assess volume depletion and renal function. 

In patients with a history of AED use, a baseline serum concentration may be useful to determine if the drug concentration is below the desired range and if a loading dose is needed. Albumin levels, renal function tests, and liver function tests can also be helpful when assessing antiepileptic therapy. 

Several studies have assessed the clinical efficacy of cyclosporine versus tacrolimus. Most of the studies have shown similar longterm patient and allograft survival, whereas some renal transplant studies have demonstrated improved renal function in tacrolimus-treated patients. The most significant difference between the two agents appears to be their adverse-reaction profiles (Table 52-4). 

Streptomycin Adults See footnote8 Children 20-40 mg/kg per day Ototoxicity, neurotoxicity, nephrotoxicity Baseline audiogram, vestibular testing, Romber testing and SCr Monthly assessments of renal function and auditory or vestibular symptoms... 

Laboratory monitoring is performed before initiating therapy and before each cycle of chemotherapy. A complete blood count should be obtained prior to each course of chemotherapy to ensure that hematologic values are adequate. In particular, white blood cell counts and absolute neutrophil counts can be decreased in patients receiving chemotherapy such as irinote-can and 5-FU and increase the risk of infection. Baseline liver function tests and an assessment of renal function should be done prior to and periodically during therapy. Other selected laboratory tests include checking for the presence of protein in the urine in patients receiving oxaliplatin and bevacizumab. 

Renal function in workers exposed to lead has also been examined in relation to bone lead, since this measurement of exposure provides a better assessment of cumulative dose of lead to the kidneys than... 

Buchet JP, Roels H, Bernard A, et al. 1980. Assessment of renal function of workers exposed to inorganic lead, cadmium, or mercury vapor. J Occup Med 22 741-750. 

Maranelli G, Apostoli P. 1987. Assessment of renal function in lead poisoned workers. Occup Environ Chem Hazards 344-348. 

Patients receiving hypouricemic medications should have baseline assessment of renal function, hepatic enzymes, complete blood count, and electrolytes. The tests should be rechecked every 6 to 12 months in patients receiving long-term prophylaxis. 

Renal function can be grossly assessed by hourly measurements of urine output, but estimation of creatinine clearance based on isolated serum creatinine values in critically ill patients may yield erroneous results. Decreased renal perfusion and aldosterone release result in sodium retention and, thus, low urinary sodium (<30 mEq/L). 

Metformin (Y) Glucophage 500, 850, 1,000 500 mg twice a day Assess renal function... 

Urinalysis can help clarify the cause of ARF. Certain laboratory parameters are helpful in the assessment of renal function with ARF (Table 75-2). Urine microscopy gives further information to assist with determination of the etiology of the ARF (Table 75-3). 

The optimal dosage regimen for patients with renal insufficiency requires an individualized assessment (Table 77-2). The optimal regimen depends on an accurate characterization of the relationship between the drug s pharmacokinetic parameters and renal function and on an accurate assessment of the patient s residual renal function. 

AALAC certified laboratory. In-housing testing included acute, subacute, and subchronic oral, dermal and inhalation studies and specialty reproductive, behavioural, haematological and renal function toxicity studies. Preparation of risk assessment, submissions and presentations to regulatory agencies and trade association. 

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