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Related Concept Videos

Factors Affecting Renal Clearance: Renal Impairment01:17

Factors Affecting Renal Clearance: Renal Impairment

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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.
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...
167
Renal Drug Clearance: Comparison Between Renal Excretion Methods01:08

Renal Drug Clearance: Comparison Between Renal Excretion Methods

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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...
300
Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

65
A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Serum Studies: Renal Function Tests01:24

Serum Studies: Renal Function Tests

55
Renal function tests are crucial for assessing kidney health, monitoring disease progression, and evaluating the kidneys' efficiency in waste elimination, fluid balance, and electrolyte regulation. These tests offer critical insights into kidney function, even though routine measurements may appear normal until there is a significant decline in the glomerular filtration rate or GFR. Typically, signs of kidney impairment only become evident when the GFR falls to about 50% of its normal level.
55
Determination of Renal Drug Clearance: Graphical and Midpoint Methods01:07

Determination of Renal Drug Clearance: Graphical and Midpoint Methods

215
Renal clearance, a crucial parameter in pharmacokinetics, can be determined using two different methods: the graphical method and the midpoint method. These methods provide insights into the rate of drug excretion by the kidneys and aid in assessing renal function.
The graphical method involves plotting the rate of drug excretion in urine against the plasma drug concentration. By analyzing the graph, the clearance can be calculated and obtained. Drugs rapidly excreted by the kidneys exhibit a...
215
Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

167
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...
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Resolving the Debate: The Future of Using Race in Estimating Kidney Function.

Cynthia Delgado1, Neil R Powe2

  • 1Nephrology Section, San Francisco VA Medical Center, San Francisco, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA.

Advances in Chronic Kidney Disease
|June 11, 2022
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Summary

The National Kidney Foundation (NKF) and American Society of Nephrology recommend removing race from kidney function tests. New equations and cystatin C use are advised to improve accuracy and address health disparities.

Keywords:
Estimated glomerular filtration rateHealth disparitiesHealth equityKidney functionRace

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Area of Science:

  • Nephrology
  • Medical Algorithms
  • Health Equity

Background:

  • Concerns regarding race-based adjustments in kidney function estimation grew in 2020.
  • Racial and social unrest prompted a national dialogue on race in healthcare algorithms.
  • The National Kidney Foundation (NKF) and American Society of Nephrology formed a task force to reassess race in diagnosing kidney disease.

Purpose of the Study:

  • To evaluate the use of race in kidney function-estimating equations.
  • To provide recommendations for updating clinical practice and future research.
  • To promote equitable kidney disease diagnosis and care.

Main Methods:

  • A task force examined evidence and expert testimony over nearly a year.
  • Reviewed existing kidney function estimation equations and their reliance on race.
  • Considered alternative markers and methods for assessing kidney function.

Main Results:

  • Recommended immediate implementation of the 2020 Chronic Kidney Disease-Epidemiology creatinine equation refit without race.
  • Advocated for increased routine use of cystatin C to confirm estimated glomerular filtration rate (eGFR).
  • Called for research into new filtration markers and addressing healthcare disparities.

Conclusions:

  • The NKF and American Society of Nephrology strongly encourage rapid adoption of these recommendations.
  • National implementation is being facilitated through laboratory engagement, clinician awareness, and patient education.
  • These changes aim to improve the accuracy of kidney function estimation and reduce health disparities.