Management of acute renal failureAcute renal failure is a common condition, frequently encountered in both community practice and hospital inpatients. While it remains a heterologous condition, following basic principles makes investigation straightforward, and initial management follows a standard pathway in most patients. This article shows this, advises on therapeutic strategies, including those in special situations, and should help the clinician in deciding when to refer to a nephrologist, and when to consider renal replacement therapy.
Kidney Disease Improving Global Outcomes Clinical Practice Guideline for Acute Kidney Injury
Diagnosis and Management of Chronic Kidney DiseaseOn completion of this article you should be able to (1) identify the 3 forms of renal damage that can cause an elevated serum creatinine level, (2) develop a plan for the initial evaluation of the patient with an elevated serum creatinine level, and (3) identify the measures that should be taken to help preserve renal function in patients with an elevated serum creatinine level.
Aintree University Hospitals NHS
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 Source: aintreerenalunit.nhs.uk |
| Clinical Resource: Guideline |
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Acute renal failure (ARF) is defined as a rapid loss of renal function due to damage to the kidneys. This results in electrolyte and acid-base abnormalities and retention of nitrogenous waste products, such as urea and creatinine.
| Source: uspharmacist.com |
| Clinical Resource: Journal Article |
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Toxic nephropathies are an important and relatively common category of kidney damage. Although they generally are reversible when detected early, they may be permanent, leading to chronic kidney disease (CKD). Toxic nephropathies are defined primarily as kidney injury caused by any number of medications, diagnostic agents, alternative products, herbal adulterants, or other toxin exposures, which includes environmental agents and chemicals.
| Source: ajkd.org |
| Clinical Resource: Journal Article |
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In this review, we discuss the common nephrotoxic renal syndromes, the mechanisms of nephrotoxicity of specific commonly used drugs, the associated risk factors for renal injury, and strategies for preventing renal injury.
| Source: mdedge.com |
| Clinical Resource: Journal Article |
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It is important to appreciate that a single drug renal toxicity can involve multiple pathophysiologic pathways and that predisposing factors are common to virtually all causative agents mediating kidney injury. Dehydration, hypotension, preexisting kidney disease, advanced age, diabetes and simultaneous use of multiple nephrotoxic drugs all greatly increase risk for any nephrotoxic drug to exert its nephrotoxic effect.
| Source: ifcc.org |
| Clinical Resource: Journal Article |
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Contrast nephropathy can occur in any patient who receives intravenous or intra-arterial contrast. There are measures available to reduce this complication and should be targeted at those patients who have pre-existing risk factors.
| Source: aintreerenalunit.nhs.uk/aintreerenal |
| Clinical Resource: Guideline |
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Frequently Asked Questions About GFR Estimates
Provides concise and direct answers to 23 frequently asked patient questions chosen by physicians about the use of glomerular filtration rate (GFR) in the evaluation of kidney function. Includes several related tables and graphs.
| Source: kidney.org |
| Clinical Resource: Frequently Asked Questions |
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Glomerular filtration rate is the best measure of kidney function | Using MDRD eGFR as a screening tool for chronic kidney disease | Limitations to use of the Cockcroft–Gault or MDRD equation | Using estimates of GFR for drug-dosage adjustments
| Source: nps.org.au |
| Clinical Resource: National Prescribing Service Publication |
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Serum creatinine : eGFR conversion table for women
Serum creatinine : eGFR conversion table for men
| Source: csnscn.ca |
| Clinical Resource: Tables |
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| Source: sheffield-kidney-institute.org |
| Clinical Resource: Calculators |
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The new CKD-EPI formula provides a more precise calculation for the measurement of eGFR, the measurement of kidney function. eGFR is now calculated using the CKD-EPI formula as it improves risk stratification.
| Source: kidney.org.au |
| Clinical Resource: Calculator |
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The purpose of this review is to examine the factors affecting drug clearance and the available evidence for drug dosing based on the CG and the abbrMDRD equations. The important differences and clinical utility of these equations should be appreciated before their use, and these are discussed.
| Source: thomasland.com |
| Clinical Resource: Journal Article |
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| Last Checked: 26/11/15 | Link Error: Report It |
Drug Dosage Adjustments in Chronic Kidney Disease: The Pharmacist’s Role
An important issue in drug therapy is dosage adjustment in chronic kidney disease (CKD). Many drugs need to be adjusted depending on a person’s kidney function; it is the pharmacist’s duty to ensure a patient is taking the optimal dose.
| Source: usask.ca |
| Clinical Resource: Drug Information Service Newsletter |
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| Last Checked: 17/02/14 | Link Error: Report It |
Adult Drug Book
Kidney Disease Programme
| Source: kdpnet.kdp.louisville.edu |
| Clinical Resource: Book |
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WHO Model Formulary 2008 > Appendix 4: Renal Impairment
| Source: who.int |
| Clinical Resource: Formulary |
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This document describes the National Kidney Disease Education Program's (NKDEP) suggestions and rationales for assessment of kidney function for drug dosing purposes.
| Source: nih.gov |
| Clinical Resource: Factsheet |
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Dose adjustment in renal impairment
Drugs for which dose adjustment should be considered in patients with renal dysfunction
| Source: druginformation.co.nz |
| Clinical Resource: Guidance |
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On average, patients with renal insufficiency are taking at least 7 different medications to manage not only their underlying disease (such as diabetes) but also the symptoms related to their renal impairment (i.e., problems with mineral metabolism, anemia). The frequency of adverse drug reactions increases with the number of medications used, the degree of renal dysfunction, the age of the patient and the number of comorbid conditions.
| Source: cmaj.ca |
| Clinical Resource: Journal Article |
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The appropriate prescribing of many drugs depends on knowledge of the patient's total renal function, which is proportional to their body mass. The Cockcroft-Gault method of calculating creatinine clearance takes into account the patient's weight. The recently introduced estimated glomerular filtration rate, which is now routinely reported with biochemistry test results, is useful for screening for renal disease, but is unsuitable for calculating doses as it does not take into account the patient's size.
| Source: nps.org.au |
| Clinical Resource: Journal Article |
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Chronic kidney disease (CKD) affects renal drug elimination and other important processes involved in drug disposition, including absorption, drug distribution and non-renal clearance. As a result, the reduced renal excretion of a drug or its metabolites can cause toxicity and the sensitivity to some drugs is increased even if elimination is unimpaired.
| Source: pccj.eu |
| Clinical Resource: Journal Article |
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Know your patient's renal function - an important prescribing consideration discusses medicines that may require renal function monitoring in the general practice setting and highlights the need to assess renal function when prescribing these medicines, especially for older people or for those with diabetes.
| Source: veteransmates.net.au |
| Clinical Resource: Brief |
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No, COX-2 inhibitors, as a class, do not worsen renal function for those without renal disease. Celecoxib is the only COX-2 inhibitor available, and it is associated with a lower risk of renal dysfunction and hypertension when compared with controls.
| Source: jfponline.com |
| Clinical Resource: Evidence Based Answer to Clinical Question |
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Dosing recommendations are based on creatinine clearance calculated using the Cockcroft-Gault equation.
Click on the antibiotic for details of each dose adjustment
| Source: gloshospitals.nhs.uk |
| Clinical Resource: Database |
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NOTE: The dosage information in this table is based on Cockroft-Gault creatinine clearance and not eGFR since the majority of the published information is based on creatinine clearance.
| Source: neessexccg.nhs.uk |
| Clinical Resource: Guideline |
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Adult Anti-Infective Dosing Guidelines 2011-2012
NewYork-Presbyterian Hospital
Recommendations for Vancomycin and Aminoglycoside Dosing
Recommendations for Dose Adjustment in Patients With Renal Dysfunction
| Source: cumc.columbia.edu |
| Clinical Resource: Guideline |
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| Last Checked: 09/03/15 | Link Error: Report It |
Renal Dosage Adjustment Guidelines for Antimicrobials
| Source: nebraskamed.com |
| Clinical Resource: Dosing Protocol |
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Dosing in Renal Insufficiency (Including with chronic ambulatory peritoneal dialysis and hemodialysis)
Dosing in Hepatic Impairment
| Source: ashm.org.au |
| Clinical Resource: Table |
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| Source: nccc.ucsf.edu |
| Clinical Resource: Table |
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| Last Checked: 25/04/16 | Link Error: Report It |
ARV Renal Dose Adjustments
| Source: washington.edu |
| Clinical Resource: Tables |
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| Last Checked: 05/01/15 | Link Error: Report It |
The manufacturer of oseltamivir revised their dosing recommendations for the use of oseltamivir in patients with renal impairment following a request by the Committee for Medicinal Products for Human Use (CHMP). These changes to the license were based on clinical data from in-house pharmacokinetic studies and modelling and simulation analysis on pharmacokinetics of oseltamivir in patients with varying degrees of renal function.
| Source: sps.nhs.uk |
| Clinical Resource: Medicines Question and Answer |
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Oseltamivir is licensed for patients undergoing haemodialysis (HD) or peritoneal dialysis (PD). There are few data available regarding the use of oseltamivir in patients receiving other forms of renal replacement therapy (RRT) and reference sources provide conflicting advice. Therefore there is no definitive dose guidance available for these patients.
| Source: sps.nhs.uk |
| Clinical Resource: Medicines Question and Answer |
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There have been a number of medication incidents reported recently involving the use of enoxaparin in patients with severe renal impairment (creatinine clearance less than 30ml/min) who, as a result of treatment have suffered a haemorrhage.
| Source: medicinesgovernance.hscni.net |
| Clinical Resource: Memo |
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Glucosamine is available in a variety of over-the-counter dietary supplements and as licensed prescription only medicines, therefore quality and content varies between products. Little information is available about herbs and dietary supplements in patients with renal impairment.
| Source: sps.nhs.uk |
| Clinical Resource: Medicines Question and Answer |
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What are the differences among modes of renal replacement therapy?
| Source: uic.edu |
| Clinical Resource: Frequently Asked Question |
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AEDS - Risk of Drug Removal by Hemodialysis
| Source: epilepsy.com |
| Clinical Resource: Table |
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| Last Checked: 08/04/14 | Link Error: Report It |
Hypertension is common in dialysed patients (>80% at pre-dialysis state, >60% in patients with hemodialysis, >30 percent in those with peritoneal dialysis). The leading cause of death in dialysed patients is cardiovascular.
| Source: eshonline.org |
| Clinical Resource: Newsletter |
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Hypertension is a major risk factor for the development and progression of chronic kidney disease (CKD) and can also be a consequence of kidney injury.
| Source: eshonline.org |
| Clinical Resource: Newsletter |
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This article reviews the general renal transport mechanisms of diuretics and compares and contrasts loop, thiazide, and thiazide-like diuretics.
| Source: thomasland.com |
| Clinical Resource: Journal Article |
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| Last Checked: 28/11/16 | Link Error: Report It |
In this report we discuss evidence from trials with hard renal end-points attempting to clarify the value of RAAS blockade for different types of hypertensive patients with CKD.
| Source: eshonline.org |
| Clinical Resource: Newsletter |
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ACE inhibitors and A2RAs are used in a wide range of indications including hypertension, heart failure, treatment post-myocardial infarction (MI), diabetes and chronic kidney disease (CKD). Prescribing can either be with an ACE inhibitor alone, an A2RA alone or, in some limited circumstances, combination therapy with an ACE inhibitor plus an A2RA.
| Source: webarchive.org.uk |
| Clinical Resource: National Prescribing Centre Publication |
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Avoid prescribing an angiotensin-converting enzyme (ACE) inhibitor and an angiotensin receptor blocker (ARB) for patients at high risk of vascular events or renal dysfunction. The combination does not reduce poor outcomes, and leads to more adverse drug-related events than an ACE inhibitor or ARB alone.
| Source: jfponline.com |
| Clinical Resource: Journal Article |
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Angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors are highly utilized classes of medications that affect the renin-angiotensin-aldosterone system (RAAS). Both have been shown to be beneficial in the treatment of disease states--such as hypertension, chronic heart failure, chronic kidney disease, and myocardial infarction--in which the RAAS system plays a significant role.
| Source: uspharmacist.com |
| Clinical Resource: Journal Article |
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| Source: uic.edu |
| Clinical Resource: Frequently Asked Question |
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| Source: nice.org.uk |
| Clinical Resource: Guidance |
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| Last Checked: 10/11/17 | Link Error: Report It |
BC Provincial Renal Agency
Anemia Management Protocol
| Source: bcrenalagency.ca |
| Clinical Resource: Protocol |
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| Last Checked: 30/12/13 | Link Error: Report It |
What is Microalbuminuria & Proteinuria
Screening for Nephropathy
Urine testing""- what samples are needed?
What other tests should be done
Interpreting the results
eGFR
Investigation of CKD in People with Diabetes - Flow Chart
Management of Diabetic Renal Disease
Guidance on use of Metformin in diabetic patients with CKD
Guidelines for the Combined Diabetes Renal Clinic at Ninewells Hospital
| Source: diabetes-healthnet.ac.uk |
| Clinical Resource: Handbook |
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| Last Checked: 30/08/16 | Link Error: Report It |
Urine Albumin-to-Creatinine Ratio (UACR)
Evaluating Patients with Diabetes for Kidney Disease presents key information about assessing UACR and GFR for diabetes educators and other healthcare professionals.
| Source: nih.gov |
| Clinical Resource: Factsheet |
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Diabetes mellitus is recognized as a leading cause of chronic kidney disease and end-stage renal failure. Chronic renal failure is associated with insulin resistance and, in advanced renal failure, decreased insulin degradation. Both of these abnormalities are partially reversed with the institution of dialysis. Except for diet with protein restriction, patients with diabetes should be preferably treated with insulin.
| Source: nih.gov |
| Clinical Resource: Journal Article |
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| Last Checked: 16/03/13 | Link Error: Report It |
The purpose of this newsletter is to provide direction on the management of gout in patients with CKD, including pertinent updates from the new guidelines.
| Source: oregonstate.edu |
| Clinical Resource: Newsletter |
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In this paper, we discuss approaches to and controversies in the management of gout and hyperuricemia in patients with CKD. Unfortunately, the evidence from clinical trials to guide treatment decisions is limited; therefore, decisions must often be based on experience and pathophysiologic principles.
| Source: mdedge.com |
| Clinical Resource: Journal Article |
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| Last Checked: 19/06/17 | Link Error: Report It |
| Source: kdigo.org |
| Clinical Resource: Guideline |
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| Last Checked: 21/08/15 | Link Error: Report It |
This issue of “Osteoporosis Clinical Updates” provides tools and suggestions for identifying those CKD patients who would benefit from treatment for osteoporosis in a general practice setting and who would be better served by referral to a specialist with experience in renal-related bone disease.
| Source: nof.org |
| Clinical Resource: Update |
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| Last Checked: 20/08/15 | Link Error: Report It |
Bone disease is commonly associated with chronic kidney disease (CKD), and the prevalence of skeletal abnormalities in those with end-stage renal disease approaches 100%. While renal osteodystrophy is the collective term for various types of uraemia-related bone remodelling, including hyperparathyroid bone disease, adynamic bone disease and osteomalacia, persons with CKD can also develop osteoporosis.
| Source: rcpe.ac.uk |
| Clinical Resource: Journal Article |
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| Source: nice.org.uk |
| Clinical Resource: Guidance |
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| Last Checked: 10/11/17 | Link Error: Report It |
Pharmacology, Efficacy, and Safety of Oral Phosphate Binders
Oral phosphate binders are required by the majority of patients on dialysis, and all of these binders can control serum levels of phosphate to similar degrees. Patient preference and adherence to prescribed therapy is at least as important as the efficacy of the prescribed binder. Avoidance of calcium-containing binders has become accepted practice where the alternatives are affordable, but incontrovertible evidence in favor of this approach is lacking.
| Source: medscape.org |
| Clinical Resource: CE / CPD / CME / Learning |
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| Last Checked: 16/03/13 | Link Error: Report It |
This article reviews factors that frequently impair nutrition status in patients with renal failure, and provides suggestions for diet, supplements, and specialized nutrition support. Nutrition assessment, monitoring, and guidelines for vitamin and mineral supplements are discussed.
| Source: virginia.edu |
| Clinical Resource: Journal Article |
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| Last Checked: 25/04/16 | Link Error: Report It |
This review will focus on nutrient metabolism in AKI as well as provide an in-depth focus on the provision of nutritional support in this vulnerable population. It is only through a comprehensive therapeutic plan including nutritional support that the mortality associated with AKI can be attenuated.
| Source: virginia.edu |
| Clinical Resource: Journal Article |
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| Last Checked: 25/04/16 | Link Error: Report It |
The paper has therefore been divided into two parts. The first part examines the prevalence, effects and mechanisms responsible for the development of protein-energy malnutrition in uraemic patients; the tools currently available for assessing nutritional status; the possible effects of the diet on the progression of kidney disease; the nutritional problems of patients with chronic renal failure in the pre-dialytic period.
The second part of the report deals with the nutritional therapy of 1) patients with chronic renal failure on haemodialytic treatment or peritoneal dialysis, 2) patients with nephrotic syndrome, 3) patients with acute renal failure and 4) kidney transplanted patients.
| Source: espen.org |
| Clinical Resource: Working Group Report |
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| Source: espen.org |
| Clinical Resource: Guideline |
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| Source: lmsg.nhs.uk |
| Clinical Resource: Guideline |
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| Last Checked: 11/04/16 | Link Error: Report It |
| Source: esprit.org.uk |
| Clinical Resource: Consensus Document |
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| Last Checked: 22/11/16 | Link Error: Report It |
ESPRIT Ciclosporin-Specific Resources
Following the introduction of alternative formulations of ciclosporin into the UK, please find below some materials that will help to communicate the potential complications that could result if a patient were inadvertently switched between ciclosporin brands.
ESPRIT Prescribing Recommendations (Extended)
ESPRIT Prescribing Recommendations (Summary)
Patient Letter
GP Letter
Transplant Clinic Poster
Patient Leaflet
Treatment Reminder Card
| Source: esprit.org.uk |
| Clinical Resource: Various |
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| Last Checked: 25/11/13 | Link Error: Report It |
American Society of Hypertension Position Paper
Management of hypertension in the transplant patient
| Source: ash-us.org |
| Clinical Resource: Position Paper |
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| Last Checked: 25/06/13 | Link Error: Report It |
What is the treatment of choice for a urinary tract infection (UTI) in a patient with renal failure?
| Source: druginformation.co.nz |
| Clinical Resource: Drug Information Service Bulletin |
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| Last Checked: 16/03/13 | Link Error: Report It |
| Source: kdigo.org |
| Clinical Resource: Guideline |
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| Last Checked: 21/08/15 | Link Error: Report It |
| Source: health.qld.gov.au |
| Clinical Resource: Guideline |
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| Last Checked: 21/08/15 | Link Error: Report It |
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