Renal function effects

Anto EIR, Chou SY, Porush JG, Shapiro WB. Infusion intravenous pyelography and renal function. Effect of hypertonic mannitol in patients with chronic renal insufficiency. Arch Intern Med 1981 141 1652-1656. 

Chang LCT, Splawinski JA, Oates JA, Nies AS. Enhanced renal prostaglandin production in the dog. Effects on renal function effects on intrarenal hemodynamics. Circ Res 1975 36 197-207. 

Penicillamine (29) can be effective in patients with refractory RA and may delay progression of erosions, but adverse effects limit its useflilness. The most common adverse side effects for penicillamine are similar to those of parenteral gold therapy, ie, pmritic rash, protein uria, leukopenia, and thrombocytopenia. Decreased or altered taste sensation is a relatively common adverse effect for penicillamine. A monthly blood count, platelet count, and urinalysis are recommended, and also hepatic and renal function should be periodically monitored. Penicillamine is teratogenic and should not be used during pregnancy. 

Kidney Function. Prostanoids influence a variety of kidney functions including renal blood flow, secretion of renin, glomerular filtration rate, and salt and water excretion. They do not have a critical role in modulating normal kidney function but play an important role when the kidney is under stress. Eor example, PGE2 and -I2 are renal vasodilators (70,71) and both are released as a result of various vasoconstrictor stimuli. They thus counterbalance the vasoconstrictor effects of the stimulus and prevent renal ischemia. The renal side effects of NSAIDS are primarily observed when normal kidney function is compromised. 

The older adult is more susceptible to the nephrotoxic effects of the cephalosporins particularly if renal function is already diminished because of age or disease. If renal impairment is present, a lower dosage and monitoring of blood creatinine levels are indicated. Bood creatinine levels greater than 4 mg/dL indicate serious renal impairment. In elderly patients with decreased renal function, a dosage adjustment may be necessary. 

Because some patients are more sensitive to side effects with digoxin, the dosage is selected carefully and adjusted as the clinical condition indicates. Adverse reactions were more common and severe in past years before careful attention to weight, renal function, and the concurrent administration of certain medications was given. The incidence and severity of digoxin toxicity has decreased significantly in recent years. 

The corticosteroids are administered with caution in older adults because they are more likely to have preexisting conditions such as congestive heart failure, hypertension, osteo-poros s and arthritis which may be worsened by the use of such agents The nurse monitors older adults for exacerbation of existing conditionsduring corticosteroid therapy. In addition, lower dosages may be needed because of the effects of aging, such as decreased muscle mass renal function, and plasma volume. 

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

However, although high potassium concentration was thought essential in early experimental work (Acquatella etcd., 1972), Fuller and Pe (1976) reported that potassium concentrations much higher than normal plasma levels led to poor renal function. A number of more recent studies have claimed that solutions containing high concentrations of sodium ions were equally or even more effective than those with high potassium (Moen et al., 1989 Sumimoto etal., 1989 Marshall etal., 1991). 

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. 

Fondaparinux has been used for the treatment of DVT and PE in two large Phase III trials and is approved by the FDA for these indications. Fondaparinux is as safe and effective as IV UFH for the treatment of PE and SC LMWH for DVT treatment.36,40 The recommended dose for fondaparinux in the treatment of VTE is based on the patient s weight (Table 7-3). Fondaparinux is renally eliminated and accumulation can occur in patients with renal dysfunction. Due to the lack of specific dosing guidelines, fondaparinux is contraindicated in patients with severe renal impairment (CrCl less than 30 mL/minute). Baseline renal function should be measured and monitored closely during the course... 

There is significant controversy over the role of loop diuretics in the treatment of ARE Theoretical benefits in hastening recovery of renal function include decreased metabolic oxygen requirements of the kidney, increased resistance to ischemia, increased urine flow rates that reduce intraluminal obstruction and filtrate backleak, and renal vasodilation.6 Theoretically, these effects could lead to increased urine output, decreased need for dialysis, improved renal recovery, and ultimately, increased survival. However, there are conflicting... 

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