FATE OF BODY MEDICINE

RENAL
is the organ that serves to
remove urine, which are
waste products of metabolism
of the body in liquid form.

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.

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.

(Pearce, 1995)

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 the
elimination of some drugs more slowly. Therefore, dosi drugs in the
primary excretion by the kidneys should be customized for each
individual.

ALLERGENNEFRON

Nephrotoxic drugs / Metalmetal

Hypovolemia

COMMON CAUSES OF
RENAL FAILURE

Pyelonephritis

Diabetes Mellitus

HYPERTENSION

(Shargel & Yu, 2005)

Excretion decreased

Bond decreased
plasma

Drug levels in the blood

increases
Toxic Effects
(Sulistia , 2009:893)

Selected drug
elimination via
the liver

Avoid the use of

tetracycline
group, diuretics,
aspirin and oral
antidiabetic

Use lower doses

than normal,
especially for
drugs primarily
eliminated
through the
kidneys

GENERAL PRINCIPLES OF DRUG USE IN RENAL FAILURE

(Sulistia , 2009:893)

(Sulistia , 2009:893)

Creatinine clearance can be calculated using

For Women, The results of the

above x 0.85

In patients with acute renal failure, is

considered <10 ml / min for the calculation of
dose adjustment
(Sulistia , 2009:893)

Dose adjustments in renal failure is mainly done for the

maintenance dose using the equation Giusti -Hayton

= 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)

Decrease maintenance dose with a fixed

interval T
=

in uremia

in normal

This was done for drugs with a narrow margin of safety, eg

digitalis, antiarrhythmics, and anticonvulsants, to avoid large
fluctuations levels
(Sulistia , 2009:893)

Extension of dose interval with a fixed maintenance dose

= dosing interval in uremia

= normal dose interval

This was done for drugs that work relies on a high level,
such as aminoglycosides.

(Sulistia , 2009:893)

1. The elimination rate constant

decreases proportionally when
kidney function decreases.
2. These renal elimination is not
(especially the metabolic rate
constants) remains unchanged.
3. Changes in renal clearance of
the drug reflected by changes in
creatinine clearance.
(Shargel & Yu, 2005)

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.
(Shargel & Yu, 2005)

(Shargel & Yu , 2005)

No dose adjustment is
necessary, if

Fraction of intact drug

excreted by the
kidneys (fr) 0:33 and
inactive metabolites,
regardless LFGnya

In LFG normal value

0.67, regardless of his
fr

(Sulistia , 2009:893)

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 kidney

failure 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.

Gunawan Sulistia.2009.Farmakologi dan Terapi.Balai Penerbit FKUI:Jakarta

Pearce, E. C, 1995, Anatomy and Physiology for the Paramedic, PT. Gramedia Pustaka
Utama, Jakarta.
Shargel, L. & Andrew B. C. Yu, 2005, Applied Biopharmaceutics and Pharmacokinetics,
Airlangga University Press, Surabaya.