根据重症儿童的iohexol血清除,增加清除的预测者
Evelyn Dhont1,2,3, Tatjana Van Der Heggen4, Evelien Snauwaert5,6
1Pediatric Intensive Care Unit, Department of Intensive Care Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium. evelyn.dhont@uzgent.be.
Pediatric nephrology (Berlin, Germany)
|November 23, 2023
概括
增加清除 (ARC) 在重症儿童中很常见,特别是在重大手术后. 识别预测因素,如估计的淋巴细胞过率 (eGFR),有助于量身定制药物剂量,以防止次治疗水平.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 药理动力学和药物剂量 药物剂量
- 儿童脏生理学 儿童脏生理学
背景情况:
- 在重症儿童中,脏清除增加 (ARC) 可能导致药物度低于治疗水平,增加风险.
- 确定预测ARC的因素对于优化儿科重症监护中的药物剂量方案至关重要.
- 淋巴膜过率 (GFR) 是功能和药物清除的关键指标.
研究的目的:
- 在重症儿童中确定增强清除 (ARC) 的预测因子.
- 描述这个患者群体中ARC的时间过程.
- 使用iohexol血清除率 (CLiohexol) 进行准确的GFR测量.
主要方法:
- 对"IOHEXOL"研究数据的回顾性分析.
- 包括患有正常血清肌素的重症儿童.
- 在PICU入院时测量CLiohexol (CLiohexol1) 和48-72小时后 (CLiohexol2);ARC定义为CLiohexol年龄特定的正常GFR+2SD.
主要成果:
- 在85名重症儿童中,有47%的儿童在PICU入院时表现出ARC (中位数CLiohexol1:122毫升/分钟/1.73米2).
- 大型非心脏手术和估计的GFR (eGFR) 是ARC的独立预测因素.
- 建议的eGFR切线用于ARC预测:99mL/min/1.73m2 (2年以下) 和140mL/min/1.73m2 (2年以上);ARC倾向于持续存在.
结论:
- PICU的临床医生应该意识到大手术后和高eGFR的儿童中ARC的风险增加.
- 积极识别患有ARC风险概况的患者可以指导初始剂量调整,以防止药物暴露不足.
- 利用eGFR值可以帮助预测和管理重症儿科患者的ARC.
相关概念视频
01:17Factors Affecting Renal Clearance: Renal Impairment
100
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...
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...
100
01:08Renal Drug Clearance: Comparison Between Renal Excretion Methods
146
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...
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...
146
01:31Factors Affecting Renal Clearance: Drug's Physicochemical Properties and Plasma Levels
239
Renal clearance of a drug is influenced by various factors, including its physicochemical properties and plasma levels. These factors play a significant role in determining how efficiently the kidneys eliminate a drug.
One important factor is the drug's molecular size. The kidneys readily excrete smaller molecules below 300 Daltons (Da). On the other hand, molecules weighing between 300 and 500 Da are excreted through both urine and bile. Larger molecules above 500 Da tend to be excreted...
One important factor is the drug's molecular size. The kidneys readily excrete smaller molecules below 300 Daltons (Da). On the other hand, molecules weighing between 300 and 500 Da are excreted through both urine and bile. Larger molecules above 500 Da tend to be excreted...
239
01:06Renal Drug Clearance: Overview
219
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...
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...
219
01:23Renal Clearance
988
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...
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...
988
01:09Factors Affecting Renal Clearance: Drug Distribution and Drug Interactions
138
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...
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...
138