1,080 results on '"Normal renal function"'
Search Results
2. PK Study in Subjects With Renal Impairment (Severe and if Required Mild & Moderate) Compared to Subjects With Normal Renal Function
- Published
- 2023
3. Case report: Near-fatal hypermagnesemia resulting from the use of Epsom salts in a patient with normal renal function
- Author
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Gui-Fei Si, Yu-Xin Ge, Xiao-Pan Lv, Yu-Quan Li, Xue-Mei Chen, and Xue-Min Yuan
- Subjects
hypermagnesemia ,Epsom salts ,magnesium sulfate ,subtotal gastrectomy ,normal renal function ,peptic ulcer ,Medicine (General) ,R5-920 - Abstract
Hypermagnesemia commonly occurs in patients with renal dysfunction. Diagnosing hypermagnesemia represents a challenge due to its rarity and the absence of routine monitoring of magnesium levels. Furthermore, the lack of awareness among clinicians regarding this uncommon condition frequently leads to delayed diagnoses. Few patients survive with a serum magnesium level exceeding 7 mmol/L. This article presents a case study of near-fatal hypermagnesemia resulting from the oral administration of Epsom salts in a patient with normal renal function. A 60-year-old female presented to the gastroenterology department on Oct. 6, 2023, with a 3-day history of black stools. She underwent subtotal gastrectomy in 2005 and has a stable history of nephrotic syndrome. To investigate the cause of her bleeding, electronic gastroscopy and colonoscopy were scheduled for Oct. 11, 2023. She experienced a sudden loss of consciousness 30 min after the ingestion of Epsom salts. The attending physician suspected a severe magnesium poisoning. She was promptly administered calcium gluconate, underwent tracheal intubation with ambu bag ventilation, and received early continuous renal replacement therapy (CRRT). Swift diagnosis and CRRT contributed to a reduction in her serum magnesium levels from an initial 8.71 mmol/L to 1.35 mmol/L, leading to a remarkable improvement in the toxic symptoms associated with hypermagnesemia. Subsequently, she was managed in the gastroenterology department, with gastroscopy revealing bleeding from the gastrointestinal anastomotic ulcer. Following conservative treatments including acid suppression, stomach protection, and hemostasis, her symptoms improved, and she was successfully discharged. This study aims to alert clinicians to the possibility of hypermagnesemia in individuals with normal renal function. Physicians should exercise caution when prescribing Epsom salts to patients with underlying gastrointestinal conditions. If necessary, alternative drug therapies may be considered to mitigate the risk of hypermagnesemia. Timely intervention is pivotal in averting life-threatening complications linked to hypermagnesemia.
- Published
- 2024
- Full Text
- View/download PDF
4. Precision Dosing of Meropenem in Adults with Normal Renal Function: Insights from a Population Pharmacokinetic and Monte Carlo Simulation Study
- Author
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Yong Kyun Kim, Gaeun Kang, Dae Young Zang, and Dong Hwan Lee
- Subjects
meropenem ,population pharmacokinetics ,noncompartmental analysis ,Monte Carlo simulation ,normal renal function ,healthy ,Therapeutics. Pharmacology ,RM1-950 - Abstract
This study aimed to develop a population pharmacokinetic (PK) model for meropenem in healthy adults and explore optimal dosing regimens for patients with normal renal function. PK samples were obtained from 12 healthy participants, which were analyzed using noncompartmental analysis and nonlinear mixed-effect modeling. The PK profiles of meropenem were characterized using a two-compartment model, and serum creatinine level was identified as a significant covariate affecting total clearance. Monte Carlo simulations were conducted using this model to inform dosing recommendations. The target index for meropenem efficacy was defined as the cumulative percentage over 24 h during which free (f) drug concentration exceeded the minimum inhibitory concentration (MIC) under steady state conditions (fT>MIC). These simulations indicated that the current dosage regimen of 1 g for 30 min infusions every 8 h achieved a 90% probability of target attainment (PTA) for 40%fT>MIC when the MIC was fT>MIC or a 90%PTA for 100%fT>4MIC, higher doses administered as 3 h extended infusions or as continuous infusions may be necessary. These results highlight the need for model-informed precision dosing to enhance the efficacy of meropenem therapy across various MIC levels and therapeutic targets.
- Published
- 2024
- Full Text
- View/download PDF
5. A model for predicting postoperative persistent acute kidney injury (AKI) in AKI after cardiac surgery patients with normal baseline renal function.
- Author
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Chen, Yuanhan, Mo, Zhiming, Chu, Hong, Hu, Penghua, Fan, Wei, Wu, Yanhua, Song, Li, Zhang, Li, Li, Zhilian, Liu, Shuangxin, Ye, Zhiming, and Liang, Xinling
- Subjects
SURGICAL complications ,INTRA-aortic balloon counterpulsation ,CARDIAC surgery ,KIDNEY physiology ,CARDIAC patients ,RECEIVER operating characteristic curves - Abstract
Background: Persistent acute kidney injury (AKI) after cardiac surgery is not uncommon and linked to poor outcomes. Hypothesis: The purpose was to develop a model for predicting postoperative persistent AKI in patients with normal baseline renal function who experienced AKI after cardiac surgery. Methods: Data from 5368 patients with normal renal function at baseline who experienced AKI after cardiopulmonary bypass cardiac surgery in our hospital were retrospectively evaluated. Among them, 3768 patients were randomly assigned to develop the model, while the remaining patients were used to validate the model. The new model was developed using logistic regression with variables selected using least absolute shrinkage and selection operator regression. Results: The incidence of persistent AKI was 50.6% in the development group. Nine variables were selected for the model, including age, hypertension, diabetes, coronary heart disease, cardiopulmonary bypass time, AKI stage at initial diagnosis after cardiac surgery, postoperative serum magnesium level of <0.8 mmol/L, postoperative duration of mechanical ventilation, and postoperative intra‐aortic balloon pump use. The model's performance was good in the validation group. The area under the receiver operating characteristic curve was 0.761 (95% confidence interval: 0.737–0.784). Observations and predictions from the model agreed well in the calibration plot. The model was also clinically useful based on decision curve analysis. Conclusions: It is feasible by using the model to identify persistent AKI after cardiac surgery in patients with normal baseline renal function who experienced postoperative AKI, which may aid in patient stratification and individualized precision treatment strategy. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
6. Refractory wounds induced by normal‐renal calciphylaxis: An under‐recognised calcific arteriolopathy.
- Author
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Wu, Jing, Chen, Lihong, Dang, Fangping, Zha, Panpan, Li, Rao, and Ran, Xingwu
- Subjects
TREATMENT of chronic kidney failure ,WOUND healing ,KIDNEYS ,SKIN ,HEMODIALYSIS ,LITERATURE reviews ,CALCIPHYLAXIS - Abstract
Background: Normal‐renal calciphylaxis (NRC) is a devastating calcific vasculopathy characterised by refractory wounds. It is more likely to be misdiagnosed because of the absence of renal insufficiency. Failure to effectively control may lead to rapid deterioration and ultimately death. However, current knowledge of it is still inadequate. Objectives: To provide a relatively comprehensive review of NRC. Methods: Nine electronic medical databases including PubMed, Web of Science, Embase, the Cochrane Library and so on were searched from inception to April 1, 2022. Articles in which calciphylaxis was diagnosed in patients with normal renal function were included. Results: Totally 140 articles were retrieved with 187 patients (median age, 62 years [IQR, 49.63 ~ 75.70 years]; 83.42% female; 84.5% Caucasian). Vitamin K antagonism (43.32%) and diabetes (39.57%) accounted for most of the concomitant factors. Cutaneous presentations were the most common. Pathological confirmation was made in 97.86% of patients with an accuracy of 99.45%. Multidisciplinary therapeutic strategies were usually implemented while the final prognosis was not ideal, with a 6‐month mortality rate of 21.10% and a 1‐year mortality rate of 27.52%. Conclusion: NRC is an under‐recognised disease caused by a variety of factors; meanwhile, multidisciplinary efforts are required to inform diagnostic and therapeutic decisions. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
7. Evaluation of Renal Function Impairment on the Pharmacokinetics of LEE011
- Published
- 2020
8. A Phase 1 Study of Roxadustat in Subjects With Different Degrees of Renal Function
- Author
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FibroGen
- Published
- 2020
9. Precision Dosing of Meropenem in Adults with Normal Renal Function: Insights from a Population Pharmacokinetic and Monte Carlo Simulation Study.
- Author
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Kim YK, Kang G, Zang DY, and Lee DH
- Abstract
This study aimed to develop a population pharmacokinetic (PK) model for meropenem in healthy adults and explore optimal dosing regimens for patients with normal renal function. PK samples were obtained from 12 healthy participants, which were analyzed using noncompartmental analysis and nonlinear mixed-effect modeling. The PK profiles of meropenem were characterized using a two-compartment model, and serum creatinine level was identified as a significant covariate affecting total clearance. Monte Carlo simulations were conducted using this model to inform dosing recommendations. The target index for meropenem efficacy was defined as the cumulative percentage over 24 h during which free ( f ) drug concentration exceeded the minimum inhibitory concentration (MIC) under steady state conditions ( f T
>MIC ). These simulations indicated that the current dosage regimen of 1 g for 30 min infusions every 8 h achieved a 90% probability of target attainment (PTA) for 40% f T>MIC when the MIC was <2 mg/L. However, to achieve more stringent therapeutic targets, such as a 90%PTA for 100% f T>MIC or a 90%PTA for 100% f T>4MIC , higher doses administered as 3 h extended infusions or as continuous infusions may be necessary. These results highlight the need for model-informed precision dosing to enhance the efficacy of meropenem therapy across various MIC levels and therapeutic targets.- Published
- 2024
- Full Text
- View/download PDF
10. Nephrology
- Author
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Goilav, Beatrice and Naga, Osama I., editor
- Published
- 2020
- Full Text
- View/download PDF
11. Comparison of Vancomycin Clearance Between Augmented Renal Clearance and Normal Renal Function in Critically Ill Infants: A Population Pharmacokinetics Study.
- Author
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Huang, Guang‐Ming, Qiu, Yue, Liu, Tao‐Tao, and Lu, Jie‐Jiu
- Subjects
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KIDNEY physiology , *GLOMERULAR filtration rate , *ACADEMIC medical centers , *CONFIDENCE intervals , *CRITICALLY ill , *PATIENTS , *VANCOMYCIN , *GESTATIONAL age , *RETROSPECTIVE studies , *MANN Whitney U Test , *DESCRIPTIVE statistics , *POPULATION health , *DATA analysis software , *CREATININE , *CHILDREN - Abstract
Augmented renal clearance presents as super‐renal function with enhanced renal perfusion and glomerular hyperfiltration in many critically ill infants. This study was to compare vancomycin clearance (CL) between critically ill infants with augmented renal clearance and with normal renal function and to optimize the vancomycin dosage. Data were retrospectively obtained from infants treated in intensive care units. Population pharmacokinetics analysis was conducted using nonlinear mixed‐effects model software. A total of 66 critically ill infants were included: 47 infants with augmented renal clearance and 19 infants with normal renal function. The median doses of vancomycin for infants with augmented renal clearance and with normal renal function were 48 and 47 mg/kg/day (P >.05), respectively. The median CL in infants with augmented renal clearance was increased 1.96‐fold compared with infants who had normal renal function (0.98 versus 0.5 L/h, P <.001). Simulations indicated that the recommended dosage of 60, 70, 80, 90, and 100 mg/kg/day would be appropriate in critically ill infants with an estimated glomerular filtration rate (eGFR) of 130–149, 150–169, 170–189, 190–209, and >210 mL/min/1.73 m2, respectively. Doses of 70 and 75 mg/kg/day were recommended for infants with augmented renal clearance and gestational ages of 27–32.9 and 33–39 weeks, respectively. Doses of 70, 75, 80, and 90 mg/kg/day were recommended for infants with augmented renal clearance and weights of 2.0–2.9, 3.0–3.9, 4.0–4.9, and 5.0–6.0 kg, respectively. In conclusion, the typical vancomycin dosage is insufficient for critically ill infants with augmented renal clearance. Premature infants and infants of low weight with augmented renal clearance need individualized dosing regimens to obtain an adequate area under the serum concentration time curve over 24 h/minimum inhibitory concentration ratio. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
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12. Derivation and validation of a model to predict acute kidney injury following cardiac surgery in patients with normal renal function
- Author
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Penghua Hu, Zhiming Mo, Yuanhan Chen, Yanhua Wu, Li Song, Li Zhang, Zhilian Li, Lei Fu, Huaban Liang, Yiming Tao, Shuangxin Liu, Zhiming Ye, and Xinling Liang
- Subjects
cardiac surgery ,acute kidney injury ,normal renal function ,risk model ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Background The study aimed to construct a clinical model based on preoperative data for predicting acute kidney injury (AKI) following cardiac surgery in patients with normal renal function. Methods A total of 22,348 consecutive patients with normal renal function undergoing cardiac surgery were enrolled. Among them, 15,701 were randomly selected for the training group and the remaining for the validation group. To develop a model visualized as a nomogram for predicting AKI, logistic regression was performed with variables selected using least absolute shrinkage and selection operator regression. The discrimination, calibration, and clinical value of the model were evaluated. Results The incidence of AKI was 25.2% in the training group. The new model consisted of nine preoperative variables, including age, male gender, left ventricular ejection fraction, hypertension, hemoglobin, uric acid, hypomagnesemia, and oral renin-angiotensin system inhibitor and non-steroidal anti-inflammatory drug within 1 week before surgery. The model had a good performance in the validation group. The discrimination was good with an area under the receiver operating characteristic curve of 0.740 (95% confidence interval, 0.726–0.753). The calibration plot indicated excellent agreement between the model prediction and actual observations. Decision curve analysis also showed that the model was clinically useful. Conclusions The new model was constructed based on nine easily available preoperative clinical data characteristics for predicting AKI following cardiac surgery in patients with normal kidney function, which may help treatment decision-making, and rational utilization of medical resources.
- Published
- 2021
- Full Text
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13. Hypercalcemia and hyperphosphatemia associated with 25-OH vitamin D deficiency in an alcoholic patient with normal renal function
- Author
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Tomohiko Asada, Minoru Iwata, Shigeru Matsuzaki, Hiroshi Hamakawa, Satoru Sengan, Toshifumi Noguchi, Kazushi Daimon, Naoki Matsumura, Morikazu Shibasaki, Tetsushi Tsujimoto, Ken Ooi, and Hidenao Fukuyama
- Subjects
25-OH vitamin D deficiency ,Hypercalcemia with hyperphosphatemia ,Alcoholic patient ,Excessive renal reabsorption ,Alcoholic liver damage ,Normal renal function ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
We present the case of a 55-year-old female patient with alcohol-related liver damage who presented with hypercalcemia and hyperphosphatemia but also showed severe paradoxical reduction in serum 25-OH vitamin D levels. The serum levels of 1, 25-(OH) 2 vitamin D, parathyroid hormone, and renal function parameters were normal. Therefore, we examined the renal reabsorption of calcium and phosphate and found a mild increase in both. The serum levels of calcium and phosphate might be determined by 1, 25-(OH) 2 vitamin D-mediated excessive renal reabsorption of calcium and phosphate in alcoholics with 25-OH vitamin D deficiency but normal renal function.
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- 2022
- Full Text
- View/download PDF
14. Derivation and validation of a model to predict acute kidney injury following cardiac surgery in patients with normal renal function.
- Author
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Hu, Penghua, Mo, Zhiming, Chen, Yuanhan, Wu, Yanhua, Song, Li, Zhang, Li, Li, Zhilian, Fu, Lei, Liang, Huaban, Tao, Yiming, Liu, Shuangxin, Ye, Zhiming, and Liang, Xinling
- Subjects
- *
ACUTE kidney failure , *CARDIAC surgery , *KIDNEY transplantation , *CLINICAL prediction rules , *KIDNEY physiology , *CARDIAC patients , *RECEIVER operating characteristic curves - Abstract
The study aimed to construct a clinical model based on preoperative data for predicting acute kidney injury (AKI) following cardiac surgery in patients with normal renal function. A total of 22,348 consecutive patients with normal renal function undergoing cardiac surgery were enrolled. Among them, 15,701 were randomly selected for the training group and the remaining for the validation group. To develop a model visualized as a nomogram for predicting AKI, logistic regression was performed with variables selected using least absolute shrinkage and selection operator regression. The discrimination, calibration, and clinical value of the model were evaluated. The incidence of AKI was 25.2% in the training group. The new model consisted of nine preoperative variables, including age, male gender, left ventricular ejection fraction, hypertension, hemoglobin, uric acid, hypomagnesemia, and oral renin-angiotensin system inhibitor and non-steroidal anti-inflammatory drug within 1 week before surgery. The model had a good performance in the validation group. The discrimination was good with an area under the receiver operating characteristic curve of 0.740 (95% confidence interval, 0.726–0.753). The calibration plot indicated excellent agreement between the model prediction and actual observations. Decision curve analysis also showed that the model was clinically useful. The new model was constructed based on nine easily available preoperative clinical data characteristics for predicting AKI following cardiac surgery in patients with normal kidney function, which may help treatment decision-making, and rational utilization of medical resources. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
15. Serum cystatin C levels are negatively correlated with post-stroke cognitive dysfunction
- Author
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Dao-Xia Guo, Zheng-Bao Zhu, Chong-Ke Zhong, Xiao-Qing Bu, Li-Hua Chen, Tan Xu, Li-Bing Guo, Jin-Tao Zhang, Dong Li, Jian-Hui Zhang, Zhong Ju, Chung-Shiuan Chen, Jing Chen, Yong-Hong Zhang, and Jiang He
- Subjects
abnormal renal function ,cognitive dysfunction ,cystatin c ,ischemic stroke ,mini-mental state examination ,neural regeneration ,neuroprotective effect ,normal renal function ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Stroke is the leading cause of death and long-term disability worldwide, and cognitive impairment and dementia are major complications of ischemic stroke. Cystatin C (CysC) has been found to be a neuroprotective factor in animal studies. However, the relationship between CysC levels and cognitive dysfunction in previous studies has revealed different results. This prospective observational study investigated the correlation between serum CysC levels and post-stroke cognitive dysfunction at 3 months. Data from 638 patients were obtained from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). Cognitive dysfunction was assessed using the Mini-Mental State Examination (MMSE) at 3 months after stroke. According to the MMSE score, 308 patients (52.9%) had post-stroke cognitive dysfunction. After adjusting for potential confounding factors, the odds ratio (95% CI) of post-stroke cognitive dysfunction for the highest quartile of serum CysC levels was 0.54 (0.30–0.98), compared with the lowest quartile. The correlation between serum CysC and cognitive dysfunction was modified by renal function status. We observed a negative linear dose-response correlation between CysC and cognitive dysfunction in patients with normal renal function (Plinearity = 0.044), but not in those with abnormal renal function. Elevated serum CysC levels were correlated with a low risk of 3-month cognitive dysfunction in patients with acute ischemic stroke, especially in those with normal renal function. The current results suggest that CysC is a protective factor for post-stroke cognitive dysfunction, and could be used to treat post-stroke cognitive dysfunction. The CATIS study was approved by the Institutional Review Boards at Soochow University from China (approval No. 2012-02) on December 30, 2012, and was registered at ClinicalTrials.gov (identifier No. NCT01840072) on April 25, 2013.
- Published
- 2020
- Full Text
- View/download PDF
16. Case report: Near-fatal hypermagnesemia resulting from the use of Epsom salts in a patient with normal renal function.
- Author
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Si GF, Ge YX, Lv XP, Li YQ, Chen XM, and Yuan XM
- Abstract
Hypermagnesemia commonly occurs in patients with renal dysfunction. Diagnosing hypermagnesemia represents a challenge due to its rarity and the absence of routine monitoring of magnesium levels. Furthermore, the lack of awareness among clinicians regarding this uncommon condition frequently leads to delayed diagnoses. Few patients survive with a serum magnesium level exceeding 7 mmol/L. This article presents a case study of near-fatal hypermagnesemia resulting from the oral administration of Epsom salts in a patient with normal renal function. A 60-year-old female presented to the gastroenterology department on Oct. 6, 2023, with a 3-day history of black stools. She underwent subtotal gastrectomy in 2005 and has a stable history of nephrotic syndrome. To investigate the cause of her bleeding, electronic gastroscopy and colonoscopy were scheduled for Oct. 11, 2023. She experienced a sudden loss of consciousness 30 min after the ingestion of Epsom salts. The attending physician suspected a severe magnesium poisoning. She was promptly administered calcium gluconate, underwent tracheal intubation with ambu bag ventilation, and received early continuous renal replacement therapy (CRRT). Swift diagnosis and CRRT contributed to a reduction in her serum magnesium levels from an initial 8.71 mmol/L to 1.35 mmol/L, leading to a remarkable improvement in the toxic symptoms associated with hypermagnesemia. Subsequently, she was managed in the gastroenterology department, with gastroscopy revealing bleeding from the gastrointestinal anastomotic ulcer. Following conservative treatments including acid suppression, stomach protection, and hemostasis, her symptoms improved, and she was successfully discharged. This study aims to alert clinicians to the possibility of hypermagnesemia in individuals with normal renal function. Physicians should exercise caution when prescribing Epsom salts to patients with underlying gastrointestinal conditions. If necessary, alternative drug therapies may be considered to mitigate the risk of hypermagnesemia. Timely intervention is pivotal in averting life-threatening complications linked to hypermagnesemia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Si, Ge, Lv, Li, Chen and Yuan.)
- Published
- 2024
- Full Text
- View/download PDF
17. Hypermagnesemia Induced Paralytic Ileus: A Case with Normal Renal Function and Review of the Literature.
- Author
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Aydın, Kutlay, Berk, Ahmet Zeki, Tokdemir, Halise, and Ergan, Begüm
- Subjects
- *
AMBULATORY surgery , *VERBAL learning , *LITERATURE reviews , *BOWEL obstructions , *INTENSIVE care units , *ALUMINUM hydroxide , *HYPOMAGNESEMIA - Abstract
Hypermagnesemia is considered to be rare and usually iatrogenic; occurring, for example, after intravenous Mg administration, oral ingestion of Mg-containing antacids or cathartics. We describe such a patient who developed severe hypermagnesemia after ingestion of unknown amount of Mg-containing oral laxatives, Sodium Phosphate and Aluminum hydroxide. A 79 year-old woman was admitted to our hospital's emergency department history of constipation and abdominal pain and vomiting. She received unknown amount magnesium (Mg) Hydroxide and Lactulose. The laboratory work-up on admission to emergency department showed magnesium 9.37 mg/dL. Abdominal X-ray showed multiple air-fluid levels concerning for small bowel obstruction (Figure 1), confirmed with abdominal computed tomography (Figure 2). She was admitted to general surgery department at the same day. The next morning she was found to be lethargic and did not respond well to verbal and painful stimuli. Then she was transferred to intensive care unit (ICU). On admission to the ICU, she was unconscious. Bowel sounds was not audible. She was immediately intubated and connected mechanical ventilation because of respiratory depression. Intravenous liquid, diuretic and calsium infusion was used. At fourth day patient has conscious and was extubated and followed by nasal oxygen therapy. Mg level was gradually decreased to 2.5 mg/ dL at fourth day. Bowel sounds were audible first. At fifth day flatus expelled first time. At seventh day patient defecated first time and at seventh day oral regim 1 was started. At eight day patient transferred to general surgery service. Mg is the fourth most abundant cation in the human body. Mg homeostasis is dependent mainly on gastrointestinal absorption and renal excretion. Massive oral Mg ingestion may result in hypermagnesemia if the absorbed amount of Mg exceeds the renal excretion capacity. Hipermagnesemia can cause ileus. Hypermagnesemia should be considered in patients, particularly in elderly presenting with ileus. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
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18. Cefepime Induced Neurotoxicity Following A Regimen Dose-Adjusted for Renal Function: Case Report and Review of the Literature
- Author
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Melissa L. Thompson Bastin, Jenni K. Thomas, Michael L. Behal, and Breanne Mefford
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Pharmacology ,medicine.medical_specialty ,business.industry ,Cefepime ,Encephalopathy ,Acute kidney injury ,Neurotoxicity ,Urology ,Renal function ,Pharmacy ,urologic and male genital diseases ,medicine.disease ,female genital diseases and pregnancy complications ,Regimen ,Normal renal function ,Original Research Articles ,medicine ,Pharmacology (medical) ,In patient ,business ,medicine.drug - Abstract
Introduction: Cefepime induced neurotoxicity (CIN) is commonly associated with renal dysfunction, however CIN can occur in patients with normal renal function or renally dose-adjusted regimens. Few reports of this kind have obtained cefepime concentrations to assist in diagnosis. Patient Case: A 42-year old female with a complex past medical history was transferred to our facility with chief complaint of worsening shock and respiratory failure, and the patient was also noted to be hypernatremic, experiencing diabetic ketoacidosis (DKA), and acute kidney injury (AKI). Her DKA resolved and hypernatremia and AKI began to improve. As a result, cefepime was dose-adjusted for renal function estimated by the Cockcroft-Gault (CG) equation. Her hospital course was complicated by persistent altered mental status (AMS), preventing extubation. Cefepime was discontinued due to concern for CIN, and a concentration was obtained 13-hours after the last dose which was elevated at 49 µg/mL. Two days following cefepime discontinuation, the patient’s mental status improved allowing for successful extubation. The patient remained stable and was discharged to an acute care floor and then ultimately back to home. Conclusion: CIN should be part of a wider differential diagnosis for patients experiencing encephalopathy, and inaccurate renal function estimation may be a risk factor for developing CIN. Furthermore, therapeutic drug monitoring (TDM) may serve as an important clinical tool in diagnosing and managing CIN.
- Published
- 2023
19. Renal Disorders
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Goilav, Beatrice, Pal, Abhijeet, and Naga, Osama, editor
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- 2015
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20. Pharmacokinetic Study of Genasense in Subjects With Normal Renal Function, Mildly Impaired Renal Function, and Moderately Impaired Renal Function
- Published
- 2012
21. Pseudohypoaldosteronism Type II or Gordon Syndrome: A Rare Syndrome of Hyperkalemia and Hypertension With Normal Renal Function.
- Author
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Manas F and Singh S
- Abstract
Pseudohypoaldosteronism type II (PHA II) or Gordon syndrome is characterized by hyperkalemia, hypertension, hyperchloremic metabolic acidosis, low plasma renin activity, and normal kidney function. We report a rare case of a young adult female patient presenting with abdominal pain, diarrhea, and vomiting. She was hypertensive during the presentation. Blood work showed mild anemia, hyperkalemia, hyperchloremia, and metabolic acidosis, with normal renal function and liver function. Plasma renin activity and aldosterone levels were low-normal. These findings were suggestive of PHA II or Gordon syndrome. It is a rare familial disease, with a non-specific presentation and no specific diagnostic criteria, and physicians should suspect it in patients with hyperkalemia in the setting of normal glomerular filtration, along with hypertension (which can be absent), metabolic acidosis, hyperchloremia, low plasma renin activity, and relatively suppressed aldosterone., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Manas et al.)
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- 2024
- Full Text
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22. Nephrogenic Systemic Fibrosis and Gadolinium-Based Contrast Media
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Thomsen, Henrik S., Reiser, Maximilian F, Series editor, Hricak, Hedvig, Series editor, Knauth, Michael, Series editor, Thomsen, Henrik S., editor, and Webb, Judith A. W., editor
- Published
- 2014
- Full Text
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23. Antihypertensive Drugs
- Author
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Findlay, Mark, Isles, Christopher, Findlay, Mark, and Isles, Christopher
- Published
- 2015
- Full Text
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24. Disorders of ECF Volume: Volume Contraction
- Author
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Alluru S. Reddi
- Subjects
medicine.medical_specialty ,Normal renal function ,Cardiac output ,Endocrinology ,Blood pressure ,Volume (thermodynamics) ,Chemistry ,Critically ill ,Internal medicine ,Extracellular fluid ,medicine ,Extracellular ,Volume contraction - Abstract
As stated in Chap. 6, the maintenance of extracellular fluid (ECF) volume is dependent on the extracellular concentration of Na+ ([Na+]). An increase in total body Na+ causes an expansion in ECF volume, and a decrease in total body Na+ reduces ECF volume. Most of the critically ill patients and patients with less availability of salt and water develop volume contraction, because it is rather difficult to induce volume contraction in humans with normal renal function. The signs and symptoms of volume contraction depend on the rapidity of Na+ loss. Sudden loss of Na+ causes a marked reduction in blood pressure and cardiac output, whereas slow and sustained loss results in a slight decrease in blood pressure. Pure water loss results in hypertonicity with high serum [Na+], whereas loss of both Na+ and water leads to low blood pressure.
- Published
- 2023
25. Low-Molecular-Weight Heparin Anti-Xa Guided Reversal of Apixaban With Prothrombin Complex Concentrate in a Patient on Hemodialysis
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David A. Moran, Brian W. Gilbert, Christina M Brummett, George J. Philip, and James S Dingman
- Subjects
medicine.medical_specialty ,Neurology ,business.industry ,medicine.drug_class ,medicine.medical_treatment ,Low molecular weight heparin ,Disease ,medicine.disease ,Prothrombin complex concentrate ,Gastroenterology ,Normal renal function ,Internal medicine ,medicine ,Pharmacology (medical) ,Apixaban ,Hemodialysis ,business ,medicine.drug ,Kidney disease - Abstract
The growing use of oral factor Xa (FXa) inhibitors in patients with chronic kidney disease (CKD), particularly the recent increased use of apixaban in patients with end-stage renal disease (ESRD), has created a new dilemma in the already controversial topic of oral FXa inhibitor reversal. With the limited availability of anti-Xa levels specific to oral FXa inhibitors and even scarcer availability of reversal data for patients on these agents with ESRD, ensuring adequate reversal is currently often solely guided by repeat imaging and changes in clinical status. Low molecular weight heparin (LMWH) anti-Xa levels have been used as a more commonly accessible test to guide the need for and efficacy of reversal of oral FXa inhibitors in patients with normal renal function. However, evidence supporting this technique is again lacking in patients with renal dysfunction. This case report focuses on the use of LMWH anti-Xa levels to guide reversal of apixaban in a patient with ESRD on hemodialysis and correlation of those levels to the patient’s clinical status.
- Published
- 2021
26. Gentamicin Dosing in Neonates with Normal Renal Function: Trough and Peak Levels
- Author
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Mark W Davies, Pieter Koorts, Kristin L. O'Connor, Karen Whitfield, and David Cartwright
- Subjects
Pharmacology ,medicine.medical_specialty ,business.industry ,Dose interval ,Dosing regimen ,Trough (economics) ,Gastroenterology ,Normal renal function ,Regimen ,Internal medicine ,Medicine ,Pharmacology (medical) ,Gentamicin ,Dosing ,business ,Prospective cohort study ,medicine.drug - Abstract
Gentamicin is commonly used in neonates, and it requires drug concentration monitoring. The objective of this study was to determine the extent of high trough (≥ 2 mg/l) and therapeutic peak serum gentamicin concentrations (5–12 mg/l) using our current gentamicin regimen and to adjust the dosing regimen accordingly and reassess. This was a prospective cohort study of neonates, with normal renal function, who were prescribed gentamicin. Group 1: March 2014–July 2017—gentamicin intravenous (IV) 2.5 mg/kg given every 36 h if 12 mg/l) or toxic trough concentrations (≥ 2 mg/l). Forty-four neonates 12 mg/l) peak concentrations. Gentamicin regimen of 2.5 mg/kg given every 36 h for neonates < 30 weeks GA and every 24 h for neonates ≥ 30 weeks GA was suboptimal at achieving therapeutic gentamicin peak. Increasing the dosage to 3.5 mg/kg achieved therapeutic peak concentrations in 98% and non-toxic trough concentrations in 86% of all neonates (prior to dose interval adjustment).
- Published
- 2021
27. Oliguria/Anuria
- Author
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Kabbani, Abdul-Rahman, Merseburger, Axel S., editor, Kuczyk, Markus A., editor, and Moul, Judd W., editor
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- 2014
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28. Tomoelastography of the Native Kidney: Regional Variation and Physiological Effects on In Vivo Renal Stiffness.
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Marticorena Garcia, Stephan Rodrigo, Grossmann, Markus, Lang, Sophia Theresa, Tzschätzsch, Heiko, Dittmann, Florian, Hamm, Bernd, Braun, Jürgen, Guo, Jing, and Sack, Ingolf
- Abstract
Purpose: To measure normal renal stiffness in adults, taking into account regional variation, hydration, and urinary status. Methods: Thirty-six healthy volunteers were examined by tomoelastography based on MR elastography at four frequencies, from 40 to 70 Hz and multifrequency shear wave speed recovery. Regional wave speeds were derived for the medulla, cortex (inner cortex and outer cortex), and renal pelvis, and examined for age-related effects. Subgroups were repeatedly examined for reproducibility, amount of prior water drinking, and urinary status. Variations in renal perfusion were simulated ex vivo using a porcine kidney subjected to venous water inflow at different pressures. Results: Shear wave speed (stiffness) of renal parenchyma was 2.46 ± 0.12 m/s (inner cortex: 2.91 ± 0.17 m/s; outer cortex: 2.52 ± 0.11 m/s; medulla: 2.15 ± 0.08 m/s) without side differences and a tendency toward softening with age (P = 0.028). Corresponding intraclass correlation for reproducibility coefficients were 0.78 (inner cortex: 0.80; outer cortex: 0.81; medulla: 0.80). Water drinking resulted in slightly higher values in inner cortex and lower values in medulla (both P = 0.039), which was consistent with the results in perfused specimens. A full bladder led to higher renal pelvis stiffness (P = 0.004), whereas renal parenchyma remained uninfluenced. Stiffness of the porcine renal cortex increased with venous inflow pressure, whereas medulla stiffness decreased.ConclusionsTomoelastography provides full field of view maps of renal stiffness with highly detailed resolution and sensitivity to physiological effects related to age and fluid–solid tissue interactions. These basic data could be used to compare pathological conditions in the future. [ABSTRACT FROM AUTHOR]
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- 2018
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29. Diseases of the Kidneys and Urinary Tract
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Minuk, Howard L., Brackenridge, R. D. C., editor, Croxson, Richard S., editor, and MacKenzie, Ross, editor
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- 2006
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30. Chemotherapy in Patients with Organ Dysfunction
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Marshall, John L., Hwang, Jimmy, Malik, Shakun, Amin, Asim, Chang, Alfred E., editor, Hayes, Daniel F., editor, Pass, Harvey I., editor, Stone, Richard M., editor, Ganz, Patricia A., editor, Kinsella, Timothy J., editor, Schiller, Joan H., editor, and Strecher, Victor J., editor
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- 2006
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31. Viral hepatitis in dialysis patients
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Girndt, Matthias, Köhler, Hans, Drukker, Parsons, Maher, Hörl, Walter H., editor, Koch, Karl M., editor, Lindsay, Robert M., editor, Ronco, Claudio, editor, and Winchester, James F., editor
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- 2004
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32. Differential Diagnosis: Hypermagnesemia
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Eltorai, Ibrahim M. and Eltorai, Ibrahim M.
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- 2016
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33. The Influence of L - Tryptophan Peroral Load on Glomerular Filtration Rate in Chronic Glomerulonephritis and Chronic Renal Failure
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Martinsons, Agris, Rudzite, Vera, Cernevskis, Harijis, Mihailova, Inese, Smeltere, Zane, Allegri, Graziella, editor, Costa, Carlo V. L., editor, Ragazzi, Eugenio, editor, Steinhart, Hans, editor, and Varesio, Luigi, editor
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- 2003
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34. Prognostic impact of 18F-FDG PET/CT in patients with multiple myeloma presenting with renal impairment
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Ga-Young Song, Sae-Ryung Kang, Cho Heejeong, Hee-Seung Bom, Hyeoung-Joon Kim, Sung-Hoon Jung, Jung-Joon Min, Deok-Hwan Yang, Chae Moon Hong, Hwa Kyung Park, Dong Won Baek, Shin Young Jeong, Jae-Sook Ahn, Joon Ho Moon, Sang Kyun Sohn, Je-Jung Lee, and Seo-Yeon Ahn
- Subjects
medicine.medical_specialty ,Prognostic factor ,Hematology ,Multivariate analysis ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Normal renal function ,Positron emission tomography ,Internal medicine ,medicine ,Fdg pet ct ,In patient ,business ,Nuclear medicine ,Multiple myeloma - Abstract
Renal insufficiency (RI) is a frequent manifestation of multiple myeloma (MM) at time of diagnosis but there is no reliable prognostic factor for patients with MM presenting with RI. This study investigated the prognostic impact of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in patients with MM with RI at diagnosis. The records of 209 patients with MM between June 2011 and November 2018 were retrospectively analyzed. PET/CT positivity was defined as the presence of more than three focal lesions or the presence of extramedullary disease. Of 209 patients, 90 (43.1%) had RI and showed similar survival outcomes to patients who had normal renal function. In total, 113 patients (54.0%) were PET/CT-positive, and 46.6% of patients with RI were PET/CT-positive at baseline. In patients with RI, those who were PET/CT-positive showed significantly inferior survival outcomes to those who were PET/CT-negative [progression-free survival (PFS), 12.7 vs. 34.0 months, P
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- 2021
35. Strategies for Rotation between Gabapentinoids in the Inpatient Setting
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Madison N. Irwin, Kyle Quirk, Michael A. Smith, Andrea Banner, and Kevin Hosseini
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Male ,medicine.medical_specialty ,Pregabalin ,03 medical and health sciences ,Normal renal function ,chemistry.chemical_compound ,0302 clinical medicine ,Primary outcome ,Internal medicine ,Post-hoc analysis ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Adverse effect ,Retrospective Studies ,Inpatients ,business.industry ,Retrospective cohort study ,Inpatient setting ,Middle Aged ,Hospitalization ,Anesthesiology and Pain Medicine ,chemistry ,Gabapentin ,business ,030217 neurology & neurosurgery ,medicine.drug ,Gabapentinoid - Abstract
Guidance and evidence to support best practices in rotating between gabapentinoids is lacking. This retrospective cohort study was performed to describe and evaluate strategies for rotation. Patients rotated while admitted from June 1st, 2014 to April 25th, 2020 at a large, academic medical center were included. The primary outcome was the proportion of rotations using a direct switch strategy compared to a cross-taper strategy. Secondary outcomes were successful rotation, defined as stable or improved pain scores pre- to post-rotation, dose ratios, and adverse effects. A total of 67 patients were included. Median age was 50 years (35 - 59) and 58% (38) were male. The majority used a direct switch strategy (87%). Ninety-five percent of patients using the direct switch strategy and 78% of patients using the cross-taper strategy were successful. There was no difference in strategies between those who were successful and those who were not. Post hoc analysis of patients with normal renal function (eGFR ≥ 50 mL/min/1.73 m2) found that those who were successful were more likely to have used a direct switch strategy (p = 0.048). There were no differences in adverse effects. These findings suggest that either strategy is reasonable for gabapentinoid rotation in the inpatient setting.
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- 2021
36. Presentation and Diagnosis of Ureteral Quadruplication: Case Report and Analysis of the Literature
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Luke L. Wang, Angela J. Beavers, and John H. Makari
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medicine.medical_specialty ,Urology ,030232 urology & nephrology ,Hydronephrosis ,urologic and male genital diseases ,Asymptomatic ,Ureteral cysts ,03 medical and health sciences ,Normal renal function ,Imaging, Three-Dimensional ,Rare Diseases ,0302 clinical medicine ,medicine ,Humans ,Cyst ,Kidney ,urogenital system ,business.industry ,Reflux ,medicine.disease ,Magnetic Resonance Imaging ,female genital diseases and pregnancy complications ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,Child, Preschool ,030220 oncology & carcinogenesis ,Asymptomatic Diseases ,Urinary Tract Infections ,Female ,Ureter ,Presentation (obstetrics) ,medicine.symptom ,business - Abstract
Ureteral quadruplication is exceedingly rare. All except for 2 cases were symptomatic and nearly all underwent intervention. We present the first case of asymptomatic ureteral quadruplication in the presence of ureteral cyst. The report is first to prove ureteral quadruplication, even with ureteral cyst, can have normal renal function and parenchyma without obstruction or reflux. The report analyzes differences between the 14 cases of ureteral quadruplication in the English literature. It is first to describe bilateral ureteral cysts with ureteral quadruplication and triplication, and is first to accurately characterize the appearance of quadruplicated ureters inside the kidney.
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- 2021
37. Mini Percutaneous Nephrolithotomy Is a Noninferior Modality to Standard Percutaneous Nephrolithotomy for the Management of 20–40 mm Renal Calculi: A Multicenter Randomized Controlled Trial
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Chao Cai, Jean J.M.C.H. de la Rosette, Jianhui Chen, Jianjun Xie, Yonggang Yu, Xun Xu, Yongda Liu, Xiang Fei, Jianfeng Mo, Jun Lu, Jiongming Li, Yong Nie, Weiguo Wang, Wenqi Wu, Xuedong Li, Xiangbo Kong, Xianen Gu, Chengyang Li, Jianzhong Li, Xiaofeng Zou, Xianzhong Duan, Hongling Sun, Houping Mao, Zhijian Zhao, Wei Zhu, Guohua Zeng, and Jian Pang
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Adult ,Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Nephrolithotomy, Percutaneous ,Renal Stone ,law.invention ,Kidney Calculi ,03 medical and health sciences ,Normal renal function ,0302 clinical medicine ,Blood loss ,Randomized controlled trial ,law ,medicine ,Operating time ,Humans ,Percutaneous nephrolithotomy ,business.industry ,Middle Aged ,Percutaneous Nephrolithotomy ,Standard ,Surgery ,Treatment Outcome ,Percutaneous nephrostomy ,030220 oncology & carcinogenesis ,Mini ,Randomized Controlled Trial ,Nephrostomy ,Female ,Mini percutaneous nephrolithotomy ,business - Abstract
Background: High quality of evidence comparing mini percutaneous nephrolithotomy (mPNL) with standard percutaneous nephrolithotomy (sPNL) for the treatment of larger-sized renal stones is lacking. Objective: To compare the efficacy and safety of mPNL and sPNL for the treatment of 20–40 mm renal stones. Design, setting, and participants: A parallel, open-label, and noninferior randomized controlled trial was performed at 20 Chinese centers (2016–2019). The inclusion criteria were patients 18–70 yr old, with normal renal function, and 20–40 mm renal stones. Intervention: Percutaneous nephrolithotomy PNL was performed using either 18 F or 24 F percutaneous nephrostomy tracts. Outcome measurements and statistical analysis: The primary outcome was the one-session stone-free rate (SFR). The secondary outcomes included operating time, visual analog pain scale (VAS) score, blood loss, complications as per the Clavien-Dindo grading system, and length of hospitalization. Results and limitations: The 1980 intention-to-treat patients were randomized. The mPNL group achieved a noninferior one-session SFR to the sPNL group by the one-side noninferiority test (0.5% [difference], p < 0.001). The transfusion and embolization rates were comparable; however, the sPNL group had a higher hemoglobin drop (5.2 g/l, p < 0.001). The sPNL yielded shorter operating time (–2.2 min, p = 0.008) but a higher VAS score (0.8, p < 0.001). Patients in the sPNL group also had longer hospitalization (0.6 d, p < 0.001). There was no statistically significant difference in fever or urosepsis occurrences. The study's main limitation was that only 18F or 24F tract sizes were used. Conclusions: Mini mPNL achieves noninferior SFR outcomes to sPNL, but with reduced bleeding, less postoperative pain, and shorter hospitalization. Patient summary: We evaluated the surgical outcomes of percutaneous nephrolithotomy using two different sizes of nephrostomy tracts in a large population. We found that the smaller tract might be a sensible alternative for patients with 20–40 mm renal stones. This multicenter, parallel, open-label, and noninferior randomized controlled trial showed that mini percutaneous nephrolithotomy achieved noninferior stone-free rate with advantages of reduced blood loss, less postoperative pain, and shorter hospitalization. Mini percutaneous nephrolithotomy should be considered a sensible alternative treatment of 20–40 mm renal stones. grants from high-level development funding of Guangzhou Medical University
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- 2021
38. Off-Pump Technique May Prevent Worsening of Renal Function in CAD with CKD Undergoing CABG
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K. Sujani, Akshay Bhati, Muralidhar Kanchi, Harish Br, Shashank Viswanathan, and Shaheen Afsal
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medicine.medical_specialty ,Creatinine ,Bypass grafting ,business.industry ,030232 urology & nephrology ,Renal function ,Disease ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Cardiac surgery ,03 medical and health sciences ,Normal renal function ,chemistry.chemical_compound ,0302 clinical medicine ,medicine.anatomical_structure ,chemistry ,Internal medicine ,Cardiology ,medicine ,Complication ,business ,Artery - Abstract
Cardiovascular disease (CVD) is a major cause for a significant proportion of all deaths and disability worldwide. Postoperative renal dysfunction following cardiac surgery is not an uncommon complication of cardiac surgery, which has serious implications with regard to morbidity, mortality, financial expenditure, and resource utilization. This study was performed to compare outcomes of patients with preoperative renal dysfunction with those having normal renal function undergoing off-pump coronary artery bypass grafting (OPCABG). Patients were divided into two categories, depending on their preoperative serum creatinine and glomerular filtration rate (GFR). The preoperative renal dysfunction was defined as serum creatinine >1.3 mg/dL and/or estimated GFR (eGFR) of
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- 2021
39. Derivation and validation of a model to predict acute kidney injury following cardiac surgery in patients with normal renal function
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Li Zhang, Yanhua Wu, Yuanhan Chen, Shuangxin Liu, Yiming Tao, Lei Fu, Huaban Liang, Zhiming Mo, Penghua Hu, Zhilian Li, Xinling Liang, Zhiming Ye, and Li Song
- Subjects
Adult ,Male ,China ,medicine.medical_specialty ,normal renal function ,Renal function ,Kidney Function Tests ,Critical Care and Intensive Care Medicine ,Logistic regression ,Risk Assessment ,Postoperative Complications ,risk model ,Risk Factors ,Internal medicine ,medicine ,Humans ,Cardiac Surgical Procedures ,Retrospective Studies ,Ejection fraction ,Receiver operating characteristic ,business.industry ,Acute kidney injury ,General Medicine ,Middle Aged ,Nomogram ,medicine.disease ,Diseases of the genitourinary system. Urology ,Confidence interval ,Cardiac surgery ,Logistic Models ,ROC Curve ,acute kidney injury ,Nephrology ,Clinical Study ,Cardiology ,Female ,RC870-923 ,business ,cardiac surgery ,Research Article - Abstract
Background The study aimed to construct a clinical model based on preoperative data for predicting acute kidney injury (AKI) following cardiac surgery in patients with normal renal function. Methods A total of 22,348 consecutive patients with normal renal function undergoing cardiac surgery were enrolled. Among them, 15,701 were randomly selected for the training group and the remaining for the validation group. To develop a model visualized as a nomogram for predicting AKI, logistic regression was performed with variables selected using least absolute shrinkage and selection operator regression. The discrimination, calibration, and clinical value of the model were evaluated. Results The incidence of AKI was 25.2% in the training group. The new model consisted of nine preoperative variables, including age, male gender, left ventricular ejection fraction, hypertension, hemoglobin, uric acid, hypomagnesemia, and oral renin-angiotensin system inhibitor and non-steroidal anti-inflammatory drug within 1 week before surgery. The model had a good performance in the validation group. The discrimination was good with an area under the receiver operating characteristic curve of 0.740 (95% confidence interval, 0.726–0.753). The calibration plot indicated excellent agreement between the model prediction and actual observations. Decision curve analysis also showed that the model was clinically useful. Conclusions The new model was constructed based on nine easily available preoperative clinical data characteristics for predicting AKI following cardiac surgery in patients with normal kidney function, which may help treatment decision-making, and rational utilization of medical resources.
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- 2021
40. Diabetic ketoacidosis in people on maintenance haemodialysis: case reports and review of literature
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James O. Burton, Chee Kay Cheung, Kath Higgins, Andrew H. Frankel, and Apexa Kuverji
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medicine.medical_specialty ,endocrine system diseases ,Diabetic ketoacidosis ,business.industry ,Maintenance haemodialysis ,nutritional and metabolic diseases ,General Medicine ,medicine.disease ,Ketoacidosis ,Normal renal function ,Diabetes mellitus ,medicine ,End-stage kidney disease ,Intensive care medicine ,business ,Kidney disease - Abstract
The management of diabetes ketoacidosis (DKA) in people with normal renal function is well established. Although DKA is less common in people with end-stage kidney disease (ESKD), when it occurs, the management needs to be adapted to account for the different physiological state that these patients present with. This report presents two cases of DKA in people on maintenance haemodialysis for ESKD. Each case identifies learning points, when combined with a comprehensive literature review, generates key recommendations on the management of DKA in people on maintenance haemodialysis.
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- 2020
41. Calciphylaxie non urémique iatrogène : une nouvelle observation
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Michèle Sanchez, Hugo Tristani, Soumaya Hamich, Brigitte Lagrange, Martin Mazereeuw, Olivier Lavelle, and Julien Rakotoson
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Calciphylaxis ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Rheopheresis ,030232 urology & nephrology ,Sodium thiosulfate ,medicine.disease ,Thrombosis ,Dermatology ,03 medical and health sciences ,Normal renal function ,chemistry.chemical_compound ,0302 clinical medicine ,chemistry ,Nephrology ,medicine ,In patient ,business ,Dialysis ,Calcification - Abstract
Calciphylaxis is a rare and severe condition, characterized by calcification and thrombosis of small vessels, mainly affecting the skin. It is most often described in patients with end-stage renal disease on dialysis. Rarer cases of non-uremic calciphylaxis are reported. The prognosis is grim and the treatment is not well codified. Sodium thiosulfate has been used for more than a decade in the treatment of uremic calciphylaxis and has been shown to be effective. Its use in non-uremic cases has been reported in a few rare observations. Rheopheresis is a technique very recently used as an adjuvant treatment in uremic calciphylaxis. We describe a case of non-uremic calciphylaxis in a patient with normal renal function and with calcium supplementation. Sodium thiosulfate was introduced, then discontinued due to the patient's poor tolerance for this treatment. Rheopheresis was then used and allowed the acceleration of healing process and a significant reduction in pain. These two treatments are promising, larger studies are needed to establish their effectiveness in non-uremic calciphylaxis.
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- 2020
42. Urologic guidelines for the care and management of people with spina bifida
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Michelle A. Baum, Rose Khavari, Rosalia Misseri, David B. Joseph, Dominic Frimberger, Stacy T. Tanaka, Hadley M. Wood, Elizabeth B. Yerkes, and Sharon Baillie
- Subjects
Adult ,Male ,medicine.medical_specialty ,Urinary infection ,Adolescent ,Best practice ,myelomeningocele ,Urinary Bladder ,030232 urology & nephrology ,Physical Therapy, Sports Therapy and Rehabilitation ,Hostility ,03 medical and health sciences ,Normal renal function ,Young Adult ,0302 clinical medicine ,030225 pediatrics ,spinal dsyraphism ,Medicine ,Humans ,Urinary Bladder, Neurogenic ,Intensive care medicine ,Child ,Spina bifida ,Spinal Dysraphism ,Urinary continence ,business.industry ,Rehabilitation ,neurogenic bladder ,Infant, Newborn ,Infant ,medicine.disease ,Urodynamics ,neural tube defects ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Practice Guidelines as Topic ,Life expectancy ,Level evidence ,Female ,medicine.symptom ,business ,Spina Bifida Guideline - Abstract
PURPOSE: The life expectancy for people with spina bifida has increased, thus resulting in greater need for guidelines in urologic care in order to protect normal renal function, to develop strategies for urinary continence, and to advance independence through adult years. METHODS: The English literature was assessed from 2002–2015; greater than 300 publications identified. Case reports and opinion pieces were eliminated leaving 100 for in depth review. Clinical questions were then established for each age group that allowed for focused assessment. RESULTS: There was no Level 1 evidence for any of the defined clinical questions. This resulted in group consensus for all questions throughout all age groups. Guidelines were provided for identifying a symptomatic urinary infection, the role of urodynamic bladder testing and identification of bladder hostility, determining methods of renal function assessment and surveillance, the initiation of continence control, and transitioning to self-care through the teen and adult years. CONCLUSION: Urologic guidelines continue to be based on clinical consensus due to the lack of high level evidence-based research. Further research is required in all aspects of urologic management. While not the “Standard of Care,” these guidelines should be considered “Best Practice”.
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- 2020
43. Diseases of The Kidneys and Urinary Tract
- Author
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Minuk, Howard L, Brackenridge, R. D. C., editor, and Elder, W. John, editor
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- 2000
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44. Case report: Atypical polycystic kidney disease
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Christopher Shin and Leonard Berliner
- Subjects
Pathology ,medicine.medical_specialty ,End-Stage Renal Disease ,R895-920 ,Autosomal dominant polycystic kidney disease ,Case Report ,Disease ,030218 nuclear medicine & medical imaging ,End stage renal disease ,Atypical polycystic kidney disease ,Medical physics. Medical radiology. Nuclear medicine ,03 medical and health sciences ,Normal renal function ,0302 clinical medicine ,medicine ,Polycystic kidney disease ,Asymmetric distribution ,Radiology, Nuclear Medicine and imaging ,Family history ,urogenital system ,business.industry ,Unilateral renal cystic disease ,Rare entity ,medicine.disease ,business ,030217 neurology & neurosurgery - Abstract
Atypical or unilateral polycystic kidney disease is a rare entity that is found incidentally and is characterized on imaging as asymmetric or unilateral distribution of cysts confined to the kidneys. We present a case of an incidental finding of atypical polycystic kidney disease in a 72-year-old male. Computed tomography imaging showed asymmetric distribution of cysts only in the kidneys and the patient had no genitourinary symptoms, had normal renal function, and did not have a family history of renal disease. Although considered to be benign, rare cases of progression of atypical polycystic kidney disease to bilateral polycystic kidney disease has been documented in the literature, which portends a worse prognosis. It is important for clinicians to be aware of this entity so that patients can be monitored periodically for progression of disease.
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- 2021
45. Two Renal Transplants From Living Donors With Horseshoe Kidneys
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Murat Sevmis, Utku Alkara, Özkan Onuk, Sema Aktas, Sinasi Sevmis, and Ozgur Merhametsiz
- Subjects
Adult ,medicine.medical_specialty ,Tissue and Organ Procurement ,Urology ,Urinary system ,030232 urology & nephrology ,Iliac fossa ,Urine ,03 medical and health sciences ,Normal renal function ,chemistry.chemical_compound ,0302 clinical medicine ,Living Donors ,medicine ,Humans ,Fused Kidney ,Donor pool ,Retrospective Studies ,Creatinine ,business.industry ,Horseshoe kidney ,medicine.disease ,Kidney Transplantation ,Surgery ,Transplantation ,medicine.anatomical_structure ,chemistry ,030220 oncology & carcinogenesis ,Tissue and Organ Harvesting ,Kidney Failure, Chronic ,Female ,business - Abstract
OBJECTIVE To present details of 2 living-related donors and our fusion division technique, where half of the horseshoe kidney (HSK) was retrieved and transplanted. METHODS Since January 2018, 461 renal transplantations have been performed at our center. In 2 of these 461 renal transplantations, which were analyzed retrospectively, a living donor, who had HSK, was used. Both donors had vascular anomalies, and the first donor also had urinary anomalies. RESULTS The transplanted kidney was placed in the recipient's contralateral iliac fossa. After perfusing for both grafts, no urine leakage was detected from the transected surfaces, and the graft began producing urine. There were no complications after surgery in the donor and recipients. The recipients were discharged on the 7th and 5th day after surgery with a creatinine level of 0.8 mg/dL and 0.9 mg/dL, respectively. The follow-up period was 24 months for the first recipient, and 12 months for the second. At the time of writing, both recipients and donors were alive with normal renal function. CONCLUSION In addition to expanding the donor pool for end-stage renal disease patients, a donor with HSK can be accepted for transplantation if no other donor option presents. Preoperative evaluation should be undertaken carefully for anatomy and HSK complications.
- Published
- 2020
46. Renal Function in Children with β-Thalassemia Major Treated with Iron Chelating Agent
- Author
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Olga Rasiyanti Siregar, Rosmayanti Siregar, and Bidasari Lubis
- Subjects
medicine.medical_specialty ,lcsh:R5-920 ,Iron Chelating ,business.industry ,Thalassemia ,Medicine (miscellaneous) ,Renal function ,medicine.disease ,Gastroenterology ,General Biochemistry, Genetics and Molecular Biology ,Iron chelation ,Abnormal hemoglobin ,Normal renal function ,Internal medicine ,hemic and lymphatic diseases ,medicine ,business ,lcsh:Medicine (General) ,Survival rate ,β thalassemia major - Abstract
BACKGROUND: Thalassemia is a disorder of inherited blood and inticated by the abnormal hemoglobin. Transfusion and iron chelation are part of thalassemia management. Iron chelating agent reduces complications due to the excess iron as a result of repeated transfusions, hence, increasing the survival rate. However, prolonged intake of iron chelating agent may increase the risk of renal function impairment. To date, evaluation of renal function in children with β-thalassemia in Medan has never been reported. The objective of this study was to evaluate renal function and other factors in children with β-thalassemia.METHODS: Fourty-five children with β-thalassemia was recruited in this study. Renal function, represented by estimated glomerular filtration rate (eGFR)and serum ferritin levels were examined. The measurement of eGFR was using Schwartz method.RESULTS: Decreased eGFR observed in some the children (2 patients) with β-thalassemia major treated with iron chelating agent. None of the factors examined had association with serum creatinine level. Children's age and duration of iron chelating agent intake had positive correlation with their eGFR (r=0.506, p
- Published
- 2020
47. Negative Impact of Borderline Creatinine Concentration and Glomerular Filtration Rate at Baseline on the Outcome of Patients With Multiple Myeloma Treated With Autologous Stem Cell Transplant
- Author
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Katarzyna Kobylinska, Pyush Vyas, Emilian Snarski, Anna Rodziewicz-Lurzynska, Anna Waszczuk-Gajda, Beata Blajer, Agnieszka Stefaniak, Jarosław Biliński, Artur Jurczyszyn, Hanna Zborowska, Magdalena Feliksbrot-Bratosiewicz, David H. Vesole, Małgorzata Król, Grzegorz W. Basak, Katarzyna Krzanowska, J. Drozd-Sokolowska, Mateusz Ziarkiewicz, Wiesław Wiktor Jędrzejczak, Paweł Kozłowski, Kamila Skwierawska, Jolanta Malyszko, Maria Król, Przemyslaw Biecek, Elżbieta Urbanowska, Jadwiga Dwilewicz-Trojaczek, Agnieszka Tomaszewska, Krzysztof Mądry, Piotr Boguradzki, and Martyna Maciejewska
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Renal function ,Transplantation, Autologous ,chemistry.chemical_compound ,Normal renal function ,Induction therapy ,Humans ,Medicine ,Renal Insufficiency ,Multiple myeloma ,Aged ,Peripheral Blood Stem Cell Transplantation ,Transplantation ,Creatinine ,Kidney ,Chemotherapy ,business.industry ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,chemistry ,Female ,Surgery ,Stem cell ,Multiple Myeloma ,business ,Glomerular Filtration Rate - Abstract
Renal impairment (RI) is one of the multiple myeloma (MM)-defining events for initiating therapy. After induction therapy, high-dose chemotherapy followed by autologous peripheral blood stem cell transplant (ASCT) remains the standard of care for transplant-eligible patients with MM. According to the International Myeloma Working Group (IMWG), the organ criterion for kidney damage is defined by a serum creatinine concentration (CrC)2 mg/dL or estimated glomerular filtration rate (eGFR) 40 mL/min. In this long-term study, we evaluated the impact of CrC and eGFR calculated by the Modification of Diet in Renal Disease equation on progression-free and overall survival using a lower threshold than the IMWG criteria.We studied the longitudinal outcomes as measured by progression-free survival and overall survival in 59 transplant-eligible patients with MM: 38 patients with normal renal function and 21 patients with RI defined as a CrC higher than upper limit of normal (≥ 1.1 mg/dL), eGFR 60 mL/min, treated with ASCT from 1998 to 2004.The risk of disease progression and death following ASCT increased by 16.5% (P = .005) and 19% (P .0009) per 1 mg/dL of CrC, respectively. The thresholds for the association of renal insufficiency and negative outcomes were CrC1.4 mg/dL and eGFR 55mL/min.We observed a negative correlation between minimal renal insufficiency and long-term outcomes. Management of patients with even marginally increased CrC and/or decreased eGFR not fulfilling IMWG RI criteria requires more concentrated effort to reverse even minimal renal insufficiency.
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- 2020
48. Percutaneous Cava Stenting in a Dog with Symptomatic Azygos Continuation of the Caudal Vena Cava
- Author
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Giovanna Bertolini and Marco Caldin
- Subjects
Nitinol stent ,medicine.medical_specialty ,Percutaneous ,General Veterinary ,040301 veterinary sciences ,business.industry ,Veterinary medicine ,Case Report ,04 agricultural and veterinary sciences ,Airflow obstruction ,030218 nuclear medicine & medical imaging ,Surgery ,0403 veterinary science ,Caudal vena cava ,03 medical and health sciences ,Normal renal function ,0302 clinical medicine ,Interventional Radiology Procedure ,SF600-1100 ,Medicine ,cardiovascular diseases ,business ,Azygos continuation ,Venous return curve - Abstract
This report describes the successful placement of a nitinol stent within the azygos continuation of the caudal vena cava in a 2-year-old, neutered female, English Bulldog with clinical and imaging signs related to venous return chronic obstruction, renal venous thrombi, and chronic renal insufficiency. This noninvasive, interventional radiology procedure was safe and clinically effective for the patient. The clinical signs were rapidly eliminated, and three years later, the patient is still in good clinical condition, with normal renal function. Venous stenting appears to be a useful, new, minimally invasive treatment option for symptomatic cavo-azygos vascular connection.
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- 2020
49. Preoperative estimated glomerular filtration rate is a marker for postoperative complications following aseptic revision total hip arthroplasty
- Author
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Alex Gu, Haley Tornberg, Joshua C. Campbell, Aaron Z. Chen, Marc D. Chodos, Nicolas A Selemon, Peter K. Sculco, Chapman Wei, and Jordan S. Cohen
- Subjects
030222 orthopedics ,medicine.medical_specialty ,Blood transfusion ,Multivariate analysis ,business.industry ,medicine.medical_treatment ,Renal function ,Retrospective cohort study ,Surgery ,03 medical and health sciences ,Normal renal function ,0302 clinical medicine ,medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Aseptic processing ,Complication ,business ,Total hip arthroplasty - Abstract
Revision total hip arthroplasty (rTHA) is increasingly performed but may carry a high rate of complication. This aim of the study was to determine if a decreased eGFR increases risks of postoperative complications following rTHA. A retrospective cohort study using the American College of Surgeons National Quality Improvement Program Database was conducted. Patients undergoing rTHA between 2007 and 2014 were identified and stratified by glomerular filtration rates (eGFR): eGFR > 125 mL/min, eGFR 90–125 mL/min, eGFR 60–90 mL/min, eGFR 30–60 mL/min, and eGFR 7 days, and unplanned return to the operating room, was assessed. The complication rates following rTHA were assessed with univariate and multivariate analysis with a significance set at p
- Published
- 2020
50. Variable linezolid exposure and response and the role of therapeutic drug monitoring: Case series
- Author
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Wael A. Alghamdi, Kenneth P. Klinker, Mohammad H. Al-Shaer, and Charles A. Peloquin
- Subjects
safety ,efficacy ,lcsh:Medicine ,Case Report ,thrombocytopenia ,Case Reports ,linezolid ,030204 cardiovascular system & hematology ,Pharmacology ,03 medical and health sciences ,Normal renal function ,chemistry.chemical_compound ,0302 clinical medicine ,Medicine ,lcsh:R5-920 ,medicine.diagnostic_test ,business.industry ,lcsh:R ,General Medicine ,monitoring ,chemistry ,Therapeutic drug monitoring ,030220 oncology & carcinogenesis ,Toxicity ,Linezolid ,Plasma concentration ,lcsh:Medicine (General) ,business - Abstract
Two patients with normal renal function, yet each showed unexpected, supra‐ and subtherapeutic linezolid plasma concentrations resulting in toxicity and ineffective therapy, respectively. TDM helps to early identify and correct such excursions.
- Published
- 2020
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