🧪 Renal Function

Renal function refers to the ability of the kidneys to filter blood, eliminate waste products, and maintain fluid, electrolyte, and acid-base balance. It also plays a key role in the clearance of many drugs, including anticoagulants and contrast agents.

• Serum Creatinine (sCr): primary marker; influenced by age, muscle mass
• Estimated Glomerular Filtration Rate (eGFR):
  • Calculated via CKD-EPI or MDRD formulas
  • Normal >90 mL/min/1.73 m²
• Creatinine Clearance (CrCl):
  • Useful for drug dosing (e.g., dabigatran)
  • Calculated via Cockcroft-Gault formula

• Renal function determines elimination of:
  • Dabigatran, enoxaparin, vancomycin, contrast media
• Impaired renal function increases risk of toxicity or delayed drug clearance
• Always assess before:
  • Contrast-enhanced imaging
  • Anticoagulant dosing
  • Nephrotoxic antibiotics

• Dabigatran: requires renal dose adjustment; reversal urgency ↑ in renal impairment
• Contrast-induced nephropathy: risk with repeated CT/MRI contrast in elderly or ICU patients
• Surgery planning: electrolyte control, fluid balance, uremia-related bleeding risk

• Rapid rise in serum creatinine
• Oliguria (<0.5 mL/kg/h)
• Elevated BUN/creatinine ratio
• Acid-base or electrolyte disturbances (↑K⁺, ↓HCO₃⁻)

• Always document baseline renal function pre-intervention
• Use eGFR/CrCl to adjust drug doses
• In patients >70 years or on nephrotoxic agents, monitor daily renal profile
• Avoid contrast or nephrotoxins when possible in acute impairment

• dabigatran_reversal_in_mild_traumatic_brain_injury
• anticoagulation_reversal_protocol
• postoperative_complications
• delayed_bleeding