Abstract
Renal impairment can be classified as acute or chronic renal disease. Renal impairment has significant effects on drug pharmacokinetics and pharmacodynamics. All aspects of drug pharmacokinetics can be affected (absorption, distribution, metabolism and excretion). Drug absorption will be reduced due to delayed gastric emptying and also due to gut edema. Drug distribution is altered due to changes in extracellular fluid volume, plasma protein binding and tissue binding of drugs. There is a decrease in drug metabolism in renal disease due to decreased activity of liver enzymes or alteration in activities of uptake and efflux transporters. Drug excretion in renal disease is affected due to changes in glomerular filtration, tubular secretion or reabsorption. Drug therapy in renal impairment should be individualized according to the extent of renal impairment and tendency of a drug used to cause nephrotoxicity. The route of elimination from the body and therapeutic index of the drugs are also important considerations.
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Bakshi Singh, S.S., Veerakumaran, J. (2015). Drugs and the Renal System. In: Chan, Y., Ng, K., Sim, D. (eds) Pharmacological Basis of Acute Care. Springer, Cham. https://doi.org/10.1007/978-3-319-10386-0_15
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DOI: https://doi.org/10.1007/978-3-319-10386-0_15
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