Drug use in renal failure

The spectrum of interaction between drugs and the kidney is broad. Most drugs are excreted at least partially by the kidney, and renal function affects drug bioavailability, volume of drug distribution, and drug metabolism and rate of drug elimination. Drug therapy not only is potentially hazardous in patients with renal failure but also can cause a number of renal diseases. The clinician should be familiar with the pharmacologic and potential toxic effects of any drug used in a patient with uremia and should monitor creatinine clearance or at least serum creatinine level as a gauge of renal function. The drug regimen can be modified according to these measurements, either by administering a constant dose and varying the interval or by varying the dose and keeping the interval constant.