It works less well in reduced GFR and may aggravate kidney selleck chemical function unless sufficient diuresis (2 L/day or more) and alkalization of urine are implemented. This agent increases uric acid excretion in the urine and may promote uric acid stone formation. It may be used in combination with Uralyt or sodium bicarbonate to keep the pH of urine between 6.2 and 6.8. Uralyt contains potassium, which may cause hyperkalemia. Contraindications for benzbromarone are urinary stones, severe renal insufficiency, or liver dysfunction. H2 blockers H2 blockers that are used for the treatment of gastric ulcer

or chronic gastritis are eliminated by the kidney. The blood concentrations are elevated in kidney dysfunction and may bring about adverse effects such as granulocytopenia or pancytopenia in CKD patients. Lafutidine, an H2 blocker, is metabolized primarily in the liver and most CHIR98014 price of the agent is excreted in bile. Thus, the dose of lafutidine should not be reduced, even in the case of reduced kidney function. Anticancer drugs Dose adjustment of anticancer drugs is made according to body surface area, but in cases of reduced kidney function it may be necessary to further consider the dosage. In some cases, it is necessary to adjust the dosage according to GFR. Cisplatin and other anticancer drugs are highly likely to injure the kidney, thus Adriamycin order requiring careful

monitoring of kidney function. The dose of carboplatin is generally determined based on GFR using Calvert’s formula. Replacement of GFR with Ccr would provide excess dosage, potentially causing severe side effects. It is therefore important to adjust the dosage by using an estimated GFR equation. Calvert’s formula Dose of carboplatin (mg/body) = area under the why curve (AUC) (mg/mL × min) × (GFR + 25) Contrast media Contrast medium-induced nephropathy is defined as the following: serum creatinine level is increased by 25% or

more, or by 0.5 mg/dL or more, within 48–72 h after contrast medium administration. The incidence of contrast media-induced nephropathy is reported to be 1–6%. Contrast media-induced nephropathy was reported to occur in 40% of the individuals in a high-risk group (risk factors are shown in Table 25-2). Therefore, in a high-risk group, examinations employing a contrast medium are done only when the advantages of image testing outweigh the disadvantages or risks of contrast-medium nephropathy. The availability of alternative imaging should be considered. In addition, FDA indicates that MRI using gadolinium as a contrast medium in CKD patients may be related to the development of nephrogenic systemic fibrosis/nephrogenic fibrosing dermopathy (NSF/NFD). Careful attention is required in the application of gadolinium-enhanced MRI. Several prophylactic measures against contrast-media nephropathy have been propounded (Table 25-3).