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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

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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.
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Factors Affecting Renal Clearance: Renal Impairment01:17

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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.
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Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
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However, dosage adjustments...
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Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance01:25

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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...
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Chronic Kidney Disease III: Interprofessional Care

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Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
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ACR Appropriateness Criteria® Indeterminate Renal Mass.

, Zhen J Wang1, Paul Nikolaidis2

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|November 6, 2020
PubMed
Summary

Incidental renal masses are commonly found. Imaging techniques like CT, MRI, and contrast-enhanced ultrasound help characterize these masses, guided by the American College of Radiology Appropriateness Criteria.

Keywords:
AUCAppropriate Use CriteriaAppropriateness CriteriaIndeterminate renal massKidney neoplasmRenal cell carcinomaRenal tumorSmall renal mass

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Area of Science:

  • Radiology
  • Medical Imaging

Background:

  • Renal masses are frequently discovered incidentally in asymptomatic patients.
  • Accurate characterization of these masses is crucial for appropriate management.

Framework:

  • Multiphase contrast-enhanced CT and MRI are primary imaging modalities for indeterminate renal masses.
  • Single-phase postcontrast dual-energy CT serves as an alternative when multiphase protocols are unavailable.

Implementation:

  • Contrast-enhanced ultrasound (CEUS) with microbubble agents offers a valuable alternative, particularly for patients with contraindications to iodinated or gadolinium-based contrast agents.
  • The American College of Radiology (ACR) Appropriateness Criteria provide evidence-based guidelines for imaging and treatment selection.

Implications:

  • ACR criteria are developed through rigorous literature review and expert consensus using established methodologies (RAND/UCLA, GRADE).
  • These guidelines aid clinicians in selecting appropriate imaging and treatment strategies for renal masses, even in cases with limited evidence.