Renal function deterioration

Maintenance of Betapace AF therapy Regularly re-evaluate renal function and QT if medically warranted. If QT is at least 520 msec (JT 430 msec or greater if QRS is greater than 100 msec), reduce the dose of Betapace AF therapy and carefully monitor patients until QT returns to less 520 msec. If the QT interval is 520 msec or more while on the lowest maintenance dose level (80 mg), discontinue the drug. If renal function deteriorates, reduce the daily dose in half by administering the drug once daily as described in Initiation of Therapy, step 3. 

In a 23-year-old woman, a kidney allograft recipient with recurrent lymphoceles treated with povidone-iodine irrigations (50 ml of a 1% solution bd for 6 days), a metabolic acidosis occurred and renal function deteriorated. After a few days, despite suspension of irrigation, the patient developed oliguria, and dialysis was needed. A renal biopsy showed acute tubular necrosis. 

Gruberg L, Mintz GS, Mehran R, et al. The prognostic implications of further renal function deterioration within 48 h of interventional coronary procedures in patients with... 

In the same way, one can also look at the results of ACE inhibition in renal insufficiency. The decrease in the rate of deterioration of renal function verifies experimental concepts and is reassuring for the prevention of long-term renal function deterioration in hypertensive patients. In untreated hypertensive patients, cerebrovascular and cardiac events occured quite frequently before renal insufficiency, which... 

It is also important to remember that renal function deteriorates with age and with Mrs RP about to commence capecitabine, it is necessary to estimate her current creatinine clearance. Based on the Cockcroft-Gault formula quoted above ... 

Taiwanese authors have reported 12 cases of suspected Chinese herb nephropathy, confirmed by renal biopsy (25). Renal function deteriorated rapidly in most patients, despite withdrawal of the Aristolochia. Seven patients underwent dialysis and the rest had slowly progressive renal insufficiency. One patient was subsequently found to have a bladder carcinoma. Other cases have been reported from mainland China (26) and Taiwan (27). 

Radiocontrast-induced renal ischemia may have contributed to the pathogenesis of the dextran-induced renal insufficiency, as has been shown in animal studies. The mechanism of dextran-induced acute renal insufficiency may be multifactorial, with elements of hyperoncotic acute renal insufficiency, tubular obstruction, and direct tubular toxicity. Radiocontrast-induced acute renal insufficiency is unusual in patients with normal baseline creatinine concentrations. The ischemic effect of radiocontrast seemed to be important in this case. Renal function should be carefully monitored if the simultaneous administration of dextran and radiocontrast is necessary. If renal function deteriorates and oliguria or anuria occurs, plasmapheresis may be an appropriate and effective approach for clearing dextran. 

Loef BG, Epema AH, SmildeTD, Henning RH, EbelsT, Navis G, Stegeman CA, Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival, J Am Soc Nephrol, 2005,16 195-200. 

BodyJJ, Diel IJ,Tripathy D, Bergstrom B. Intravenous ibandronate does not affect time to renal function deterioration in patients with skeletal metastases from breast cancer phase III trial results. Eur J Cancer Care (Engl) 2006 15 299-302. 

Unusual immune side-effects have also been reported in association with IFNa therapy. Chronic hemolytic uremic syndrome was observed in a patient with multiple myeloma treated with IFNa (De Broe ME, personal communication). The post bone marrow transplantation course was complicated and he received several nephrotoxic antibiotics. Three months later a treatment with IFNa was started. Towards the end of the treatment renal function deteriorated. There was partial renal recovery after cessation of therapy. Renal biopsy showed focal mesangio-capillary lesions, mesangiolysis and intracapillary thrombosis consistent with a chronic form of hemolytic uremic syndrome. Ra-vandi-Kashani et al. [49] and Harvey et al. [50] reported 3 other cases of HUS/TTP. Two patients developed renal failure requiring dialysis. E. coli OH157.H7 was grown from the stool of one patient. 

Patients should be monitored closely for therapeutic response as well as the development of treatment-related toxicities. While the rate of renal function deterioration is an important indicator of the long-term success of treatment, resolution of nephrotic and nephritic signs and symptoms associated with the glomerulopathies are important short-term therapeutic targets. 

Hyperkalemia poses an immediate threat to the life of the uremic patient. Although potassium excretion decreases with increasing nephron loss, hyperkalemia occurs infrequently in stable chronic renal failure when the glomerular filtration rate exceeds 10 ml/minute. Serum potassium, however, may rise sharply if renal function deteriorates suddenly or if an excessive potassium load enters the extracellular fluid space. The latter event may result from dietary indiscretion extracellular shift of potassium by acidemia potassium release by hemolysis, rhabdomyolysis, or tumor lysis, or administration of potassium-containing drugs. 

Renal functional deterioration usually occurs within the first few days of therapy, and may be detected after only a few doses or, more rarely, later in the course of treatment [5-15]. Patients may be asymptomatic, but nausea, vomiting, and abdominal, back, or flank pain are common. Oliguria is uncommon. The rise in the serum creatinine concentration is usually modest, and dialysis has only rarely been necessary. Most patients recover renal function within 3 to 14 days of stopping acyclovir therapy, reducing the dose, or increasing hydration [5, 6, 8-15]. Urinalysis usually shows mild proteinuria, microscopic hematuria, and variable degrees of pyuria. Birefringent needle-shaped crystals may be seen either free or within white blood cells in the urine sediment [10]. It should be noted, however, that acy-... 

Comparative studies In a two-center, retrospective study in 409 renal transplant recipients, the primary calcineurin-based immunosuppressive regimen was converted to an mTC)R inhibitor-based regimen at least 3 months after transplantation [37 ]. The rates of mTOR inhibitor withdrawal because of adverse reactions among those who converted to everolimus ( = 220) or sirolimus ( = 189) were compared. Everolimus was withdrawn in 69 patients (31%) and sirolimus in 43 (23%). The most important causes were severe infections (everolimus 2.3% sirolimus 4.8%), pneumonitis (everolimus 6.8% sirolimus 4.8%), acute rejection episodes (everolimus 4.1% sirolimus 1.6%), proteinuria (everolimus 4.1% sirolimus 1.6%), renal function deterioration (everolimus 2.3% sirolimus 2.1%), and severe rashes (everolimus 2.3% sirolimus 0.5%). Although the overall incidence of withdrawal because of adverse reactions was higher with everolimus, the frequency of severe adverse reactions was not higher. 

Within a few days of going onto the mixture the average urinary volume increased from 3 to 6 litres/day. The urinary osmolality rapidly fell below that of the slightly elevated plasma osmolality. Renal function deteriorated rapidly blood urea levels rose from 30 to 300mg/100ml., and creatinine clearances fell from 100 to 20mls/min. 

As renal function deteriorated there was a proportional increase in urinary levels of orotic acid and orotidine. This increased excretion would appear to be related to the increase in plasma oxipurinol levels which have been reported in renal failure (5) ... 

When continuous vancomycin in 119 patients was compared with intermittent administration in 30 patients after elective cardiac surgery, renal function deteriorated in 28% and 37% respectively [95. ... 

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