Renal function, measurement

Renal function Measurement of effects on urine excretion in saline loaded rats Renal dynamics Measurement of renal blood flow, GFR and clearance... 

In the following section, we will focus on markers and methods for measuring the GFR because data for dynamic and continuous renal function measurements are available. In doing so, we acknowledge the importance of tubular secretion and fixation markers in the overall evaluation of renal status, and the reader is referred to some articles covering these subjects [174,176-182]. 

The GFR is considered to be the most reliable measure of the functional capacity of the kidneys and is often thought of as indicative of the number of functioning nephrons. As a physiological measurement, it has proved to be the most sensitive and specific marker of changes in overall renal function. Measurement of GFR is discussed in Chapter 24,... 

A drug which, by its actions on the heart, increases cardiac output and which is therefore used in the treatment of heart failure. It has to be used cautiously because of toxic effects. Elderly patients are particularly sensitive and overdosage occurs frequently, probably due to impaired renal function. Measurement of serum levels is therefore a useful guide to treatment. It can be measured by radioimmunoassay or enzyme-immunoassay. 

Cardiac nuclear imaging using Tc -red blood cells can measure the fraction of blood pumped by the heart during each beat. Tc -DTPA and sodium (9-iodohippurate, C H INNaO, are used to measure renal function of the kidney. The enhanced or diminished uptake of... 

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. 

RISK FOR INEFFECTIVE TISSUE PERFUSION RENAL When the patient is taking a drag tiiat is potentially toxic to die kidneys, die nurse must carefully monitor fluid intake and output. In some instances, die nurse may need to perform hourly measurements of die urinary output. Periodic laboratory tests are usually ordered to monitor the patient s response to therapy and to detect toxic drag reactions. Seram creatinine levels and BUN levels are checked frequentiy during the course of therapy to monitor kidney function. If the BUN exceeds 40 mg dL or if the serum creatinine level exceeds 3 mg cIL, the primary health care provider may discontinue the drug therapy or reduce the dosage until renal function improves. 

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

Differences among individuals can partially explain the differences in the before workshift and end of workshift levels of trichloroethylene and its metabolites. Increased respiration rate during a workday, induced by physical workload, has been shown to affect levels of unchanged trichloroethylene more than its metabolites, while the amount of body fat influences the levels of the solvent and its metabolites in breath, blood, and urine samples before workshift exposure (Sato 1993). Additionally, liver function affects measurements of exhaled solvent at the end of workshift increased metabolism of trichloroethylene will tend to decrease the amount exhaled after a workshift. Increased renal function would affect levels of TCA and trichloroethanol in blood before a workshift in the same way, but it probably would not affect urine values between the begiiming and the end of the workshift because of the slow excretion rate of TCA. 

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... 

The prototype of this class is hirudin, which was originally isolated from the salivary glands of the medicinal leech, Hirudo medicinalis. Hirudin itself is not commercially available, but recombinant technology has permitted production of hirudin derivatives, namely lepirudin and desirudin.29,38,41 Lepirudin has a short half-life of approximately 40 minutes after IV administration and 120 minutes when given SC. Elimination of lepirudin is primarily renal therefore, doses must be adjusted based on the patient s renal function. The dose should be monitored and adjusted to achieve an aPTT ratio of 1.5 to 2.5 times the baseline measurement. Lepirudin is currently approved for use in patients with HIT and related thrombosis. Up to 40% of patients treated with lepirudin will develop antibodies to the drug.29,38,41... 

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... 

Taken together, these studies provide some evidence for the association of chronic nephropathy in occupationally exposed workers with PbB levels ranging from 60 to >100 pg/dL. It should be noted, however, that PbB levels measured at the time of renal function testing may not fully reflect the exposure history that contributed to the development of chronic nephropathy in lead workers. 

In some human studies where clinical chemistry measurements but no renal biopsies were performed, the only parameter of renal function shown to be affected was an increase in the levels of NAG in the urine. NAG is a lysosomal enzyme present in renal tubular cells that has been shown to be a sensitive indicator of early subclinical renal tubular disease. The mechanism by which lead affects the release of NAG from renal tubular cells is not known, but it is suggested that lead could attach to kidney cell membranes and alter membrane permeability (Chia et al. 1994). 

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). 

In patients who cannot tolerate voriconazole, amphotericin B can be used. Full doses (1 to 1.5 mg/kg/day) are generally recommended, with response measured by defervescence and radiographic clearing. The lipid-based formulations may be preferred as initial therapy in patients with marginal renal function or in patients receiving other nephrotoxic drugs. The optimal duration of treatment is unknown. 

Serum creatinine is not a good measure of renal function in elderly because muscle mass is reduced and the production of creatinine is thus reduced. Estimation of GFR based on serum creatinine is therefore not accurate enough in the elderly (Baracskay et al. 1997). Creatinine clearance should be used instead. Another possibility is measurement of cystatin C in plasma. The rate of production of cystatin C is relatively constant so it seems to be a more reliable estimation of GFR also in older adults. 

A measurement of renal function (creatinine and/or BUN) is an essential test for most clinical studies, as is the inclusion of an panel of liver function tests (SGOT, SGPT, LDH, CPK, GGT, and/or alkaline phosphatase). The specific tests chosen to be included in a study are somewhat dependent on both the investigator s and/or clinical scientist s experiences and the characteristics of the drug. Other important parameters to measure include serum electrolytes and at least some of the tests listed in Table 20.12. 

The glomerular filtration rate (GFR) defines how much plasma water passes from the blood into the top of the nephron per minute. In health, the true GFR for a 70 kg adult is typically 100-120 ml/minute. Expressed another way, we can say that, in health, every minute each of the approximately 2 million glomeruli present in both adult kidneys filters between 0.05 and 0.06 pi of plasma water. The GFR is a good overall measure of renal function and the clinical laboratory has many ways of estimating its value. 

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