الفهرس 
Anatomy and physiology of urinary tract
Glomerular filtrationOnly 14 pages are availabe for public view
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Abstract
Patients in an ICU are approximately twice as likely to experience an
adverse drug event when compared to patients in a general medicine unit.
This increased risk is resulting from the greater number of medical risk
factors faced by patients in the ICU, plus their wider range of drug
exposures , Renal failure is a major risk factor for adverse drug events that
not only place patients at increased risk for morbidity and mortality, they
also have a tremendous impact financially.
Patients with renal impairment have more risk for adverse drug events as
they often have alterations in their pharmacokinetic parameters such as drug
absorption, distribution, protein binding, biotransformation and renal
excretion ,leading to drug-related problems and medication dosing errors
Appropriate drug selection and dosing for patients with renal impairment
can maximize therapeutic efficacy and minimize toxicity , in addition to
avoidance of costs associated with drug-related toxicity and in cost savings
in terms of drug costs.
For patients with non-dialyzed renal failure , physician and pharmacist
can work together to have a safe drug prescription using a stepwise approach
that entails intial assessment of the patient general condition and comorbidities , then evaluation of the degree of the renal impairment ,then
proper choice of drugs of no or minimal toxicity , in addition to dose
adjustment of drugs according to the degree of renal impairment not only
via drug dose modification but also via proper choice of method of administration and considering drug-drug interaction and dosing according
to clinical condition of the patient .
For patients with dialyzed renal failure ,dialysis drug clearance may
significantly reduce drug efficacy if it is not accounted for , the extent to
which a drug is affected by dialysis is determined primarily by complex
interaction of many factors, including the characteristics of the drug such as
molecular size, protein binding, volume of distribution, water solubility, and
plasma clearance ,and technical aspects of the dialysis procedure that also
may determine the extent to which a drug is removed by dialysis.
Many drug properties that affect removal by hemodialysis also apply to
peritoneal dialysis, but peritoneal dialysis is usually less efficient , on the
contrary , drug clearance by continuous renal replacement therapy differs
from intermittent hemodialysis , relying on continuous ultrafiltration of
plasma water, continuous renal replacement can remove large quantities of
ultra filterable drug .
We conclude from the above that special consideration should be taken
when drugs are prescribed to patients with impaired renal function , This
can be complex and require a stepwise approach to ensure effectiveness,
minimize further damage and prevent drug nephrotoxicity.