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Radionuclide Examination of the Kidneys
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Accurate measurement of creatinine clearance requires urine collection over an extended time interval, often 24 hours, which is not always possible with all patients and in all clinical circumstances. Kidney function is thus frequently only estimated by simple methods (creatinine concentration in plasma and prediction equations) developed for the purpose. In comparison with creatinine clearance, they are less accurate, and their interpretation should be based on adequate knowledge of their limits [22].
Renal diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
The dilated collecting system can retain some of the urine meant to be saved for the twenty-four hour urine collections. As a result, creatinine clearance may be underestimated, unless the collection is done carefully and the patient is volume repleted before the test. If in the last few hours of the collection the patient is maintained in the left lateral recumbent position, the chances of obtaining a full collection are also increased.
Medication and dementia
Published in Graham A. Jackson, Debbie Tolson, Textbook of Dementia Care, 2019
The older we get, the less able we are to clear drugs from our bodies. Figure 17.2 shows decreasing rates of creatinine clearance by the kidneys with increasing age. Creatinine is a waste product of metabolism that the kidneys filter out of blood. Creatinine clearance is therefore a measure of the kidneys’ ability to filter blood. The kidneys are an important route of elimination of drugs from the body and similar variations with increasing age will occur with other routes.
Zero-contrast imaging for the assessment of transcatheter aortic valve implantation in candidates with renal dysfunction
Published in Renal Failure, 2023
Guy F. A. Prado, Stefano Garzon, Jose Mariani, Adriano Caixeta, Breno O. Almeida, Felipe O. Ramalho, Marcelo L. C. Vieira, Claudio H. Fischer, Gilberto Szarf, Walther Ishikawa, Pedro A. Lemos
Between July 2017 and June 2022, 188 patients underwent TAVI at our institution. The proposed zero-contrast pre-TAVI evaluation was applied to 10 male patients. The mean age was 81.26 (±12.2), diabetes was present in 7 patients; the mean Society of Thoracic Surgeons score for mortality was 10.9 (±8.7), the median aortic valve calcium score was 2709.5 AU (IQR: 1601.75–4218.25). At baseline, mean serum creatinine and creatinine clearance were 2.64 ± 0.72 mg/dL and 26.85 ± 12.55 mL/min, respectively. In seven patients, the aortic annulus area was observed to be numerically larger when evaluated using MRI as opposed to TEE. Among these patients, a size difference of more than 10% was evident in five cases, when comparing both assessment methods. Conversely, in the remaining three patients, TEE demonstrated a larger annulus size than MRI. However, among these cases, the differences were less than 2% in two instances, with only one case showing a difference of 9.5%. The clinical characteristics and main findings of the multi-modality imaging are summarized in Tables 1 and 2, respectively. The renal function remained unaltered after the multi-modality imaging protocol (post imaging serum creatinine: 2.66 ± 0.73 mg/dL; post imaging creatinine clearance: 26.76 ± 11.51 mL/min; p-value = 0.8 and 0.9 respectively). After TAVI, there was a numerically slight improvement in renal function compared to baseline, but without statistical significance (post-TAVI serum creatinine: 2.45 ± 0.89 mg/dL; post-TAVI creatinine clearance: 29.84 ± 13.98 mL/min; p-value = 0.4 and 0.1 respectively).
CYP3A4*22 and CYP3A5*3 impact efficacy and safety of diazepam in patients with alcohol withdrawal syndrome
Published in Nordic Journal of Psychiatry, 2023
Valentin Yurievich Skryabin, Johan Franck, Volker Martin Lauschke, Mikhail Sergeevich Zastrozhin, Valery Valerievich Shipitsyn, Evgeny Alekseevich Bryun, Dmitry Alekseevich Sychev
The study enrolled 100 patients (average age: 43 ± 10 years) hospitalized for the treatment of AWS in a psychiatric in-patient treatment facility in Moscow, Russia. Patients were invited to participate on the first day of inpatient treatment, prior to the initiation of therapy. Inclusion criteria: (a) a diagnosis of ‘Mental and behavioral disorders due to use of alcohol. Withdrawal state, uncomplicated’ (F10.30), according to ICD-10); (b) written informed consent; abstinence from alcohol for at least 8 h, but no longer than 48 h prior to the inclusion in study; (c) presence of anxiety in the clinical presentation of the patient; (d) Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar) score more than 10. Exclusion criteria: (a) presence of any other mental disorder or severe somatic disorder (except alcoholic hepatitis and toxic encephalopathy); (b) presence of any other psychotropic medication; (c) creatinine clearance <50 mL/min; (d) plasma creatinine ≥1.5 mg/dL (133 mmol/L); e) body weight <60 kg or >100 kg; (f) age 75 years or more; (g) presence of any contraindication for diazepam.
Plazomicin: an intravenous aminoglycoside antibacterial for the treatment of complicated urinary tract infections
Published in Expert Review of Anti-infective Therapy, 2020
Anastasia Bilinskaya, Kristin E. Linder, Joseph L. Kuti
In the EPIC trial, 19.5% (59/303) patients in the plazomicin group experienced an adverse event, with the most frequently reported being diarrhea (2.3%), hypertension (2.3%), headache (1.3%), nausea (1.3%), vomiting (1.3%), and hypotension (1.3%) [62]. Eleven (3.6%) patients experienced an adverse event related to renal function defined as increased serum creatinine, decrease in creatinine clearance, acute kidney injury, renal failure, renal impairment, and chronic kidney diseases. A serum creatinine increase ≥0.5 mg/dL was observed in 7% (21/300) of patients treated with plazomicin at any time during the trial compared with 4% (12/297) of patients treated with meropenem. Risk factors for increases in serum creatinine were baseline moderate renal impairment and duration of therapy exceeding 5 days. Of the 11 patients that had an increase in serum creatinine during intravenous therapy, 9 (81.9%) patients made a full recovery at the last follow up visit with a serum creatinine < 0.5 mg/dL above their baseline. Only one (0.3%) patient experienced an adverse event related to cochlear or vestibular function. Six patients in each treatment group discontinued treatment as a result of adverse events, most frequently associated with renal function [62].