Renal function tests

Administration may result in nausea, vomiting, diarrhea, rash, anemia, leukopenia, and thrombocytopenia Signs of renal impairment include elevated blood urea nitrogen (BUN) and serum creatinine levels. Periodic renal function tests are usually performed during therapy. 

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. 

Serum levels (digoxin) may be ordered daily during the period of digitalization and periodically during maintenance therapy. Periodic electrocardiograms, serum electrolytes, hepatic and renal function tests, and other laboratory studies also may be ordered. 

All patients with major patterns are monitored for rhabdomyolysis and renal failure. An early sign of rhabdomyolysis is an elevated serum uric acid, associated with an increase in serum CK. Within 8 to 12 hours, the serum tests are repeated. If the uric acid falls and the CK rises, rhabdomyolysis is likely. Renal function tests may also be increased at this time. When the diagnosis of rhabdomyolysis is made, the patient is treated with 40 mg furose-mide IV once, and IV fluids. Urine myoglobin concentrations are obtained. If the patient develops renal failure, hemodialysis or peritoneal dialysis may be necessary. In all cases, multiple drug intoxication, trauma, and rhabdomyolysis are ruled out or treated. All patients are kept under observation until they are asymptomatic. 

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. 

Exam General Chemistry 3 Hematologic Tests" Metabolic Tests6 Liver Function Tests Renal Function Tests Thyroid Function Tests Serum Electrolytes Dermatologic6 ... 

Nursing Implications Monitor CBC, urinalysis, renal function tests Periodically evaluate renal and hematologic systems during prolonged therapy do not inject into gluteal muscle in children less than 2 years of age... 

Histopathological evidence of renal damage has been observed in lead-exposed workers. Renal ultrastructure and function were examined in five men with heavy occupational exposure to lead (Cramer et al. 1974). In addition, renal function was evaluated in two men from whom renal biopsies were not obtained. PbB levels ranged from 71 to 138 pg/dL. Renal function tests were normal in all except for a reduced glomerular filtration rate in one worker. Two subjects with relatively short exposure to lead (6 weeks and 8 months) and PbB levels of 89-129 pg/dL had intranuclear inclusions in the proximal tubules. Renal biopsies from workers with longer periods of lead exposure (4-20 years, PbB levels of 71-138 pg/dL) had diffuse interstitial or peritubular fibrosis. Glomeruli were normal in all subjects. 

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. 

Current nutritional intake Complete blood cell count Serum electrolytes Sodium Potassium Chloride Bicarbonate Magnesium Phosphorous Calcium Serum glucose Serum albumin Markers for organ function Liver function tests Alkaline phosphatase Aspartate aminotransferase Alanine aminotransferase Total bilirubin Prothrombin time or International normalized ratio Renal function tests Blood urea nitrogen Creatinine Fluid balance Input Oral... 

Renal function tests Blood urea nitrogen Creatinine... 

Baseline laboratory tests should include complete blood cell count, prothrombin time, activated partial thromboplastin time, liver and renal function tests, and serum carcinoembryonic antigen (CEA). Serum CEA can serve as a marker for monitoring colorectal cancer response to treatment, but it is too insensitive and nonspecific to be used as a screening test for early-stage colorectal cancer. 

Androgen synthesis inhibitors provide symptomatic, but brief, relief in approximately 50% of patients. Aminoglutethimide causes adverse effects in 50% of patients, such as lethargy, ataxia, dizziness, and self-limiting rash. The adverse effects of ketoconazole are GI intolerance, transient increases in liver and renal function tests, and hypoadrenalism. 

For urethral overactivity and/or bladder underactivity, digital rectal exam or transrectal ultrasound should be performed to rule out prostate enlargement. Renal function tests should be performed to rule out renal failure. 

Renal Effects. Renal function tests (serum creatinine and urate, urinary hemoglobin, protein and glucose) completed in 11 hexachloroethane workers were within the normal range (Selden et al. 1994). Plasma hexachloroethane levels in these workers, who wore protective equipment, were 7.3 + 6.04 pg/L at the time of the tests (Selden et al. 1993). Mild skin and mucous membrane irritation were reported in the exposed group, suggesting that exposure may have been through either the inhalation or dermal routes of exposure. 

Renal Effects. No effects on renal function tests (serum creatinine and urate, urinary hemoglobin, protein and glucose) were noted in 11 hexachloroethane-exposed workers who wore protective clothing (Selden et al. 1994). 

Methotrexate is an antimetabolite, which is metabolised by the renal and hepatic systems and may lead to renal and hepatic toxicities. Liver and renal function tests are therefore carried out for patients who are administered the drug. Methotrexate can lead to myelosuppression and therefore full blood counts must be monitored for patients taking it. 

Begley J, Reichart AW, Seismen AW, et al Association between renal function tests and pentachlorophenol exposure. Clin Toxicol 11 97-106, 1977... 

Monitoring Monitor initially and periodically thereafter body weight, blood pressure, fluid, and electrolyte balance signs and symptoms of pericardial effusion ECG changes CBC alkaline phosphatase renal function tests. 

Monitoring Periodic monitoring for toxicity, including CBC with differential and platelet counts, and liver and renal function testing is mandatory. Periodic liver biopsies may be indicated in some situations. Monitor patients at increased risk for impaired methotrexate elimination (eg, renal dysfunction, pleural effusions, ascites) more frequently (see Precautions). 

Abelcet-. Chills, fever, increased serum creatinine, multiple organ failure AmBisome-. Hypokalemia, hypomagnesemia, hyperglycemia, hypocalcemia, edema, abdominal pain, back pain, chills, chest pain, hypotension, diarrhea, nausea, vomiting, headache, fever, rigors, insomnia, dyspnea, epistaxis, increased liver/renal function test results... 

Hgb levels, intake and output, and renal function test results... 

Intake and output and renal function test results to assess for nephrotoxicity... 

Dosaye in renal impairment Dosage modification is usually unnecessary but liver and renal function test results should be monitored in those with both renal and liver impairment or severe renal impairment. 

Toxicity—Initial hematocrit, fecal occult blood, then q6-l 2 mo electrolytes and renal function tests q6-12 mo LFTs q6-12 mo in high-risk patients query patient for dyspepsia, nausea, vomiting, right upper abdominal pain, anorexia, fatigue, jaundice, edema, weight gain, decreased urine output... 

Urinary Ca, alkaline phosphatase, renal function tests... 

Renal function tests, liver function tests, and serum electrolytes before and periodically during therapy... 

Toxicity Serum electrolytes (especially potassium), renal function tests, BP, ECG (hyperkalemia), signs and symptoms of toxicity... 

CBC, liver and renal function test results, urine output, BUN level, and serum alkaline phosphatase, bilirubin, and creatinine levels... 

Blood pressure, heart rate, respiratory rate, CBCwith differential, and hepatic function. For those on long-term therapy, expect blood chemistry studies and hepatic and renal function tests to be performed periodically... 

Periodic CBC, liver and renal function tests, serum folate, vitamin D during prolonged therapy... 

CBC and hepatic and renal function tests periodically, as ordered, for patients on long-term therapy... 

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