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The glomerulus and Bowman's capsule are two essential components of the nephron, which is the functional unit of the kidney. These microscopic structures play a critical role in the process of blood filtration to produce urine.
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As primary excretory organs, the kidneys maintain homeostasis by removing waste substances from the bloodstream. They comprise over a million units called nephrons, which serve as the kidney's functional units.
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The kidneys are two large bean-shaped organs located in the upper abdomen. They filter the blood several times a day to remove toxins and rebalance water and electrolytes of the circulatory system via the renal veins. The kidneys receive blood directly from the heart via the renal arteries. These arteries enter the kidney at the hilum, the concave surface of the bean, where they branch and divide into smaller vessels and capillaries.
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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.
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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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Renal Drug Excretion: Tubular Reabsorption01:25

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Tubular reabsorption, a process occurring post-glomerular filtration of drugs in the renal tubule, is a critical determinant of drug half-life. During the process of renal excretion, as the glomerular filtrate progresses to the distal convoluted tubule (DCT), drugs that are highly permeable, lipophilic, and nonionized undergo passive reabsorption from the tubular fluid into the surrounding peritubular capillaries. This reabsorption process restricts their elimination through the kidneys. This...
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Continuous Kidney Replacement Therapies: Core Curriculum 2025.

J Pedro Teixeira1, Swapnil Hiremath2, Abdulghani Omar Kabli2

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Continuous kidney replacement therapy (CKRT) is a standard for critically ill patients with acute kidney injury (AKI), despite lacking proven survival benefits over intermittent KRT. This review covers CKRT principles, prescription, and care.

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Area of Science:

  • Nephrology
  • Intensive Care Medicine
  • Critical Care

Background:

  • Critically ill patients often require kidney replacement therapy (KRT).
  • Continuous KRT (CKRT) is the preferred method for hemodynamically unstable patients in the intensive care unit (ICU).
  • CKRT is standard for acute kidney injury (AKI) in shock, brain injury, and liver failure, despite unproven survival advantages over intermittent KRT.

Purpose of the Study:

  • To review the principles and application of CKRT in critical care.
  • To guide the prescription of CKRT, including timing, dosing, access, and anticoagulation.
  • To highlight essential components of multidisciplinary care for CKRT patients.

Main Methods:

  • Review of physicochemical principles of CKRT.
  • Summary of seminal trials on CKRT initiation, dosing, vascular access, and anticoagulation.
  • Discussion of practical aspects of CKRT prescription and multidisciplinary care.

Main Results:

  • CKRT is widely adopted as standard care for AKI in critically ill patients.
  • Evidence does not consistently show superior survival or kidney recovery with CKRT compared to intermittent KRT.
  • CKRT use is expected to increase with expanding organ support therapies.

Conclusions:

  • CKRT is a cornerstone therapy for AKI in complex ICU patients.
  • Optimal CKRT management requires understanding its principles, evidence-based prescription, and comprehensive care.
  • Multidisciplinary care, including drug dosing, nutrition, and rehabilitation, is crucial for high-value CKRT delivery.