Renal function monitoring

Are aldosterone antagonists utilized in appropriate patients with proper electrolyte and renal function monitoring ... 

CrCl greater than or equal to 30 to less than 50 mL/minute) and severe (CrCl less than 30 mL/minute) renal impairment respectively. Renal function monitoring is recommended prior to initiation and periodically thereafter. Adverse events in clinical trials included nasopharyngitis (5.2%), upper respiratory tract infection (6.3%), and headache (5.1%). Currently, no significant drug interactions are known. 

Continuous Renal Function Monitoring with Exogenous Organ-Specific Clearance Markers... 

While still preliminary, this study demonstrates the feasibility of evaluating the renal status in real-time by optical modality. This continuous renal function monitoring by the optical modality represents a new and minimally invasive method to detect kidney malfunctions. In addition to using relatively harmless radiation, the simplicity and portability of the equipment make this approach compatible for use in ambulatory and critical care. However, further studies... 

Renal function impairment Use with caution in severe renal disease because these agents may precipitate azotemia. Cumulative effects of the drug may develop in patients with impaired renal function. Monitor renal function periodically. Metolazone is the only thiazide-like diuretic that may produce diuresis in patients with GFR less than 20 mL/min. Indapamide may also be useful in patients with impaired renal function. 

Elderly Because elderly patients are more likely to have decreased renal function, monitor renal function and make dose adjustments accordingly. 

At one time, sustained-release preparations were thought to reduce renal toxicity, but more recent evidence has cast doubt on this assumption ( 313). A patient on long-term maintenance lithium should have renal function monitored periodically (i.e., every 12 months) with a urinalysis, BUN, and creatinine. If abnormal, a more intensive evaluation should include 24-hour urine osmolality and creatinine clearance. It is advisable to reduce maintenance lithium to optimal minimal dose-blood levels and, if possible, to avoid concomitant antipsychotics, which may enhance toxicity. Some data support the use of a once-a-day dose schedule to minimize peak lithium concentrations over a 24-hour period (314). 

Table 2 Common parameters of renal function monitored in in vivo studies...

UACH To evaluate impact of renal function monitoring program, focusing on appropriate dosages of imipenem OD None None DCA Potential to save 11,500 annually by adjusting imipenem dosages on basis of renal function Input costs not considered no control group clinical outcomes not considered... 

Another marker of sufficient tissue perfusion can be clinical assessment of end-organ function. As mentioned previously, prevention of MODS is an important factor in reducing ARDS-associated mortality. ChnicaUy, assessments of urine output and serum electrolytes are important aspects of renal function monitoring, whereas liver function tests (aminotransferases AST and ALT) are important laboratory parameters for monitoring hepatic function. Central nervous system assessment can be difficult in the ARDS patient and is confounded by concurrent drug therapies (e.g., sedatives, narcotics, etc.) that alter neurologic status. 

Types of Animal Tests Tests done with animals often include general screening tests for pharmacologic effects, hepatic and renal function monitoring, blood and urine tests, gross and histopathologic examination of tissues, and tests of reproductive effects and carcinogenicity. 

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