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Related Concept Videos

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant01:25

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant

In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration01:28

Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration

Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area. This equation is...
Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance01:25

Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance

In healthy individuals, serum creatinine levels remain stable due to a balance between its constant production—primarily from muscle metabolism—and renal excretion. Creatinine is freely filtered by the glomeruli, making it a valuable marker for estimating renal function. When the glomerular filtration rate (GFR) decreases, the kidneys can only eliminate less creatinine, causing serum levels to rise.Serum creatinine concentration is widely used to estimate creatinine clearance (Clcr), a...
Drug Dosing in Renal Diseases: Measurement of Glomerular Filtration Rate01:25

Drug Dosing in Renal Diseases: Measurement of Glomerular Filtration Rate

The glomerular filtration rate (GFR) is a critical indicator of kidney health, reflecting how well the kidneys filter blood. Changes in GFR can signal potential kidney impairment, necessitating accurate measurement methods to monitor kidney function effectively.Various molecules can serve as markers for GFR measurement, with the ideal marker meeting several specific criteria. It must freely filter at the glomerulus, avoid reabsorption or secretion by the renal tubules, remain unmetabolized, not...
Factors Affecting Renal Clearance: Renal Impairment01:17

Factors Affecting Renal Clearance: Renal Impairment

Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...

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Benchmark dose approach for renal dysfunction in workers exposed to lead.

Tian Lin1, Jin Tai-Yi

  • 1Department of Occupational and Environmental Health, School of Public Health and Family Medicine, Capital Medical University, Peijing, PR China.

Environmental Toxicology
|May 15, 2007
PubMed
Summary

Lead exposure in workers can cause kidney dysfunction. Urinary N-acetyl-beta-D-glucosaminidase (NAG) is an early biomarker, with a blood lead level of 250 µg/L serving as a warning signal for renal health.

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Published on: September 4, 2017

Area of Science:

  • Occupational Health
  • Toxicology
  • Nephrology

Background:

  • Lead exposure is a significant occupational hazard.
  • Lead-induced renal dysfunction is a serious health concern.
  • Biomarkers are needed to assess early kidney damage from lead.

Purpose of the Study:

  • To determine biologic exposure limits for lead-induced renal dysfunction.
  • To identify sensitive biomarkers for early detection of kidney damage.
  • To establish a warning blood lead level for occupational exposure.

Main Methods:

  • Quantal linear logistic regression model (BMDS) used to calculate benchmark dose (BMD) and lower confidence limit (BMDL).
  • Studied relationship between blood lead concentration and urinary biomarkers: total protein (TP), beta2-microglobulin (beta2-MG), and N-acetyl-beta-D-glucosaminidase (NAG).
  • Compared lead-exposed workers (n=135) with a control group of mechanics (n=143).

Main Results:

  • Lead-exposed workers showed elevated levels of NAG, beta2-MG, and TP compared to controls.
  • These biomarkers increased with higher blood lead levels and longer employment duration.
  • BMD and BMDL for renal dysfunction ranged from 299.4-588.7 µg/L and 253.4-402.3 µg/L, respectively.

Conclusions:

  • Urinary NAG activity is a sensitive and early biomarker for lead-induced renal tubular dysfunction.
  • A blood lead level of 250 µg/L is suggested as a warning signal for occupational lead exposure.
  • Establishing BMDLs provides crucial data for setting occupational exposure limits and protecting worker renal health.