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Related Concept Videos

Factors Affecting Renal Clearance: Renal Impairment01:17

Factors Affecting Renal Clearance: Renal Impairment

232
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...
232
Renal Drug Clearance: Overview01:06

Renal Drug Clearance: Overview

443
Renal clearance is a crucial parameter in pharmacokinetics that quantifies the rate at which the kidneys excrete a drug. It represents a constant fraction of the central volume of distribution containing the drug that the kidney eliminates per unit of time.
Renal clearance can be calculated using different methods. One approach is to divide the urinary drug excretion rate by the plasma drug concentration. This method directly measures renal clearance, indicating the kidneys' efficiency in...
443
Renal Clearance01:23

Renal Clearance

1.9K
The glomerular filtration rate (GFR) is a critical marker of kidney function, reflecting the efficiency of filtration by the glomeruli. Renal clearance of specific substances, such as inulin or creatinine, is commonly used to measure GFR.
Renal clearance refers to the volume of plasma cleared of a specific substance, such as creatinine, per unit of time. To measure clearance, urine samples are collected over a 24-hour period during each bladder voiding, followed by a single blood sample at the...
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Renal Drug Clearance: Comparison Between Renal Excretion Methods01:08

Renal Drug Clearance: Comparison Between Renal Excretion Methods

393
Renal clearance is a critical parameter encompassing kidney filtration, secretion, and reabsorption processes. It is calculated using a specific equation to determine the rate at which the kidneys clear a drug.
Renal clearance is often associated with the renal glomerular filtration rate (GFR), which represents the rate at which plasma is filtered through the glomeruli in the kidney. When drug reabsorption is minimal and there is no active secretion, renal clearance is closely related to the...
393
Factors Affecting Renal Clearance: Drug Distribution and Drug Interactions01:09

Factors Affecting Renal Clearance: Drug Distribution and Drug Interactions

301
Renal clearance plays a pivotal role in drug elimination from the body and can be influenced by drug distribution and interactions. Understanding these factors is crucial in pharmacology as they impact the effectiveness and duration of drug therapy.
One important factor is the relationship between renal clearance and the apparent volume of distribution. Renal clearance tends to be inversely proportional to the apparent volume of distribution. Drugs with an extensive distribution volume or those...
301
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

38
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...
38

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Related Experiment Video

Updated: Nov 3, 2025

Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography
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Augmented renal clearance. An unnoticed relevant event.

Teresa M Tomasa-Irriguible1, Joan Sabater-Riera2, Marcos Pérez-Carrasco3

  • 1Intensive Care Department, Germans Trias i Pujol Hospital, Barcelona, Spain.

Science Progress
|June 3, 2021
PubMed
Summary

Augmented renal clearance (ARC) affects 30% of ICU patients, potentially leading to underdosing of renally cleared drugs. This dynamic condition is common on admission and not accurately estimated by the CKD-EPI formula.

Keywords:
ARCAugmented renal clearanceCKD-EPIChronic Kidney Disease Epidemiology Collaboration formulaGFRcritically ill patientglomerular filtrate rateprevalence

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Area of Science:

  • Critical Care Medicine
  • Pharmacokinetics
  • Nephrology

Background:

  • Augmented renal clearance (ARC) can cause therapeutic failure of renally cleared drugs.
  • Understanding ARC prevalence and characteristics in critically ill patients is crucial for optimizing drug dosing.

Purpose of the Study:

  • To determine the prevalence of ARC in critically ill patients.
  • To monitor glomerular filtration rate (GFR) during follow-up.
  • To assess the concordance between CKD-EPI estimated GFR and measured GFR.

Main Methods:

  • An observational, prospective, multicenter study involving 561 critically ill patients.
  • ARC defined as creatinine clearance > 130 ml/min/1.73 m².
  • GFR measurements performed twice weekly over a 2-month period.

Main Results:

  • ARC prevalence was 30%, with 10.7% detected upon ICU admission.
  • ARC patients were younger (56.5 vs. 66 years) and had lower ICU mortality (6.9% vs. 14.5%).
  • No GFR pattern was observed during follow-up, and CKD-EPI formula showed poor concordance with measured GFR.

Conclusions:

  • ARC is a common, dynamic phenomenon in critically ill patients, often present on admission.
  • ARC can lead to significant underdosing of renally eliminated medications.
  • The CKD-EPI formula is unreliable for estimating creatinine clearance in patients with ARC.