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Related Concept Videos

Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

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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.
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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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...
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Dialysis01:27

Dialysis

314
Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
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Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
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Post Liver Transplant Renal Dysfunction-Evaluation, Management and Immunosuppressive Practice.

Kaiser Raja1, Charles Panackel2

  • 1Department of Gastroenterology and Hepatology, King's College Hospital London, Dubai, United Arab Emirates.

Journal of Clinical and Experimental Hepatology
|January 26, 2024
PubMed
Summary

Liver transplantation improves survival but can lead to kidney problems. Early identification and nephroprotective strategies are crucial for managing kidney dysfunction after liver transplants.

Keywords:
acute kidney injurycalcineurin inhibitorchronic kidney diseaseliver transplantationmycophenolate mofetil

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Area of Science:

  • Nephrology
  • Hepatology
  • Transplantation Medicine

Background:

  • Liver transplantation (LT) offers improved survival for end-stage liver disease and liver cancer.
  • Metabolic complications, particularly renal dysfunction (acute kidney injury and chronic kidney disease), remain significant challenges post-LT.
  • Current methods for predicting and diagnosing kidney injury after LT are limited.

Purpose of the Study:

  • To critically evaluate the reasons for renal failure following liver transplantation.
  • To review diagnostic techniques for post-LT renal dysfunction.
  • To assess therapies for preserving renal function immediately and long-term after LT.

Main Methods:

  • Review of literature on post-liver transplantation renal dysfunction.
  • Analysis of factors contributing to kidney injury, including pre-transplant comorbidities, perioperative events, and immunosuppressive medications.
  • Evaluation of current and emerging diagnostic and therapeutic strategies.

Main Results:

  • Post-LT renal dysfunction is multifactorial, influenced by pre-existing conditions, perioperative factors, and nephrotoxic immunosuppressants like calcineurin inhibitors (CNIs).
  • The Model for End-Stage Liver Disease (MELD) score impacts peri-transplant AKI and long-term CKD.
  • Early nephroprotective measures, including delayed CNI initiation and dose reduction, are advised.

Conclusions:

  • Proactive identification of at-risk patients and preventive strategies are essential pre-transplant.
  • Nephroprotective strategies during LT focus on hemodynamic stability.
  • Optimizing immunosuppression regimens (e.g., CNI minimization, combination therapy) is key to managing post-LT kidney disease.