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FATE OF BODY MEDICINE


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RENAL

is the organ that serves to

remove urine, which are

waste products of metabolism

of the body in liquid form. Renal function is to regulate

the water balance in the body,regulating the concentration of

salt in the blood, regulate the

balance of acid - alkaline blood

and regulate the excretion of

waste material and excess salt.

When renals fail in its function,

there will be a disruption in water

balance and metabolism in the

body. Thus resulting in the buildup

of harmful substances in the

blood. (Pearce, 1995)


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Renal

excretion

Is one of the important mechanisms involved in the removal of

drugs from the workplace. Effects of a single dose of the drug will

be extended and the concentration of the saturated state (steady

state) will increase if the process decreases. In patients with renal

failure there is a decrease in renal blood flow, organ size,

glomeruler and tubular function. These changes resulted in theelimination of some drugs more slowly. Therefore, dosi drugs in the

primary excretion by the kidneys should be customized for each

individual.


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COMMON CAUSES OF

RENAL FAILURE

ALLERGENNEFRON

HypovolemiaNephrotoxic drugs / Metal-

metal

Diabetes Mellitus

HYPERTENSION

Pyelonephritis

(Shargel & Yu, 2005)


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Excretion decreased

Drug levels in the blood

increases

Toxic Effects

Bond decreasedplasma

(Sulistia , 2009:893)


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Selected drugelimination via

the liver

Avoid the use oftetracycline

group, diuretics,

aspirin and oralantidiabetic

Use lower doses

than normal,especially for

drugs primarilyeliminated

through thekidneys

GENERAL PRINCIPLES OF DRUG USE IN RENAL FAILURE

(Sulistia , 2009:893)


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Creatinine clearance can be calculated using

For Women, The results of the

above x 0.85

In patients with acute renal failure, is

considered


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Dose adjustments in renal failure is mainly done for the

maintenance dose using the equation Giusti -Hayton

G = The correction factor Giustiayton

= Fraction of drug elimination by the kidneys

= creatinine clearance in uremia= normal creatinine clearance

Furthermore, G is used to lower the dose or extend

the maintenance interval T

(Sulistia , 2009:893)


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Decrease maintenance dose with a fixed

interval T

= in uremia

= in normal

This was done for drugs with a narrow margin of safety, egdigitalis, antiarrhythmics, and anticonvulsants, to avoid large

fluctuations levels

(Sulistia , 2009:893)


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This was done for drugs that work relies on a high level,

such as aminoglycosides.

Extension of dose interval with a fixed maintenance dose

= dosing interval in uremia

= normal dose interval

(Sulistia , 2009:893)


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3. Changes in renal clearance of

the drug reflected by changes in

creatinine clearance.

2. These renal elimination is not

(especially the metabolic rate

constants) remains unchanged.

1. The elimination rate constant

decreases proportionally when

kidney function decreases.



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There are several methods to estimate the appropriate

dosage regime for a patient with renal damage. The

design rules for people with uremia dose based on

pharmacokinetic changes that occur in connection with

the condition of uremia.



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No dose adjustment isnecessary, if

Fraction of intact drugexcreted by the

kidneys (fr) 0:33 andinactive metabolites,

regardless LFGnya

In LFG normal value

0.67, regardless of hisfr

(Sulistia , 2009:893)


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CONCLUSION

There are two general approaches for pharmacokinetics were

dose adjustments include methods based on drug clearance and

a method based on the elimination half-life.

A dosage regime can be designed for patients with kidneyfailure by either lowering the normal dose of the drug and

keep the frequency of dosing (dosing interval) that is

constant or by decreasing the frequency of dosing

(extending the dosing interval) and maintain a constant

dose.


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