Highly illustrated with images that are relevant to diagnosis and treatment Structured in line with clinical practice working methods rather than through a disease or subject based approach Written from a global perspective by an expert in the field. Front Matter Pages i-xii. Pages Technical Handling of Renal Biopsy Specimens. Indication for Biopsy: Nephrotic Syndrome.
Indication for Biopsy: Acute Kidney Injury. Indication for Biopsy: Chronic Renal Failure. Indication for Biopsy: Hematuria.
Indication for Biopsy: Proteinuria. Indication for Biopsy: Renal Allograft. The Handbook is not intended to offer definitive advice or guidance on how drugs should be used in patients with renal impairment, nor is it a comprehensive and complete list of all drugs licensed in the UK. For more in-depth information, users are advised to refer to the Summary of Product Characteristics, the British National Formulary, package inserts or other product data.
In renal impairment these parameters are often variable and interrelated in a complex manner. This may be further complicated if the patient is undergoing renal replacement therapy. For many drugs, some or even all of the altered pharmacokinetic parameters and modified interrelationships are unknown. In such circumstances, the informed professional judgement of clinicians and pharmacists must be used to predict drug disposition.
This must be based on knowledge of the drug, its class, chemistry and pharmacokinetics in patients with normal renal function. Sensitivity to some drugs is increased, even if elimination is unimpaired. Many side-effects are particularly poorly tolerated by renally impaired patients. Some drugs are ineffective when renal function is reduced. Consequently, one can justifiably assume mild renal impairment when prescribing for the elderly.
Many of these problems can be avoided by careful choice and use of drugs. This Handbook seeks to assist healthcare professionals in this process.
Clinical use: A brief account of the more common indications in renally impaired patients is given. Where an indication is unlicensed, this is usually stated. Dose in normal renal function: The doses quoted for patients with normal renal function are generally the licensed dosage recommendations stated in the Summary of Product Characteristics for each drug.
Where a product is not licensed in the UK, dosage guidelines are provided by the relevant drug company. Pharmacokinetics: Basic pharmacokinetic data such as molecular weight, halflife, percentage protein-binding, volume of distribution and percentage excreted unchanged in the urine are quoted, to assist in predicting drug handling in both renal impairment and renal replacement therapy.
For renally excreted drugs with a narrow therapeutic index, the total daily maintenance dose may be reduced either by decreasing the dose or by increasing the dosing interval, or sometimes by a combination of both. Dosing guidelines for varying degrees of renal impairment are stated accordingly. Thus the clinician or pharmacist should use informed professional judgement, based on knowledge of the drug and its pharmacokinetics, when deciding whether to further modify dosing regimens.
It should be noted that HDF removes drugs more efficiently than HD, although there is limited information in this area. They are defined as those interactions which are potentially serious, and where combined administration of the drugs involved should be avoided, or only undertaken with caution and appropriate monitoring.
Users of the monographs are referred to Appendix 1 of the British National Formulary for a more comprehensive list of interactions deemed to be not so clinically significant.
Administration : Information is given on reconstitution, route and rate of administration, and other relevant factors. The authors give very helpful information on pharmacokinetics and common indications for the use of each drug described. This information is not available in any other single textbook. It is an invaluable resource for all healthcare professionals but particularly for those involved in the care of renal patients.
Individuals with renal disease require continuing support and care throughout their lives from renal nurses and other members of the inter-professional renal team. Advanced Renal Care is for all those who work in nephrology, dialysis and transplantation as it addresses current challenges in caring for those with renal failure, and examines recent trends and likely future developments.
The book also explores key issues in staff recruitment and development. It goes beyond the basic texts on renal care by discussing topical issues such as anaemia management, care of older people on dialysis, diabetes and renal failure, infection control and sexual dysfunction in renal disease.
The thoroughly revised and updated Third Edition of this popular handbook provides practical and accessible information on all aspects of dialysis.
The section on hemodialysis features expanded chapters on physiologic principles, acute hemodialysis, urea kinetic modeling, and vascular access, while the section on peritoneal dialysis has been extensively reworked by a new editor and now includes two new chapters.
Each chapter provides references to relevant websites.
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