Transl Clin Pharmacol.  2018 Sep;26(3):111-114. 10.12793/tcp.2018.26.3.111.

Augmented renal clearance

• Atkinson A

• KMID: 2420292
• DOI: http://doi.org/10.12793/tcp.2018.26.3.111

Abstract

Adding to the complexity of caring for critically ill patients is the fact that many of them have a creatinine clearance that exceeds 130 mL/min/1.73 m². This phenomenon, termed augmented renal clearance (ARC), has only recently been widely recognized and its pathogenesis remains incompletely understood. However, ARC has been shown to result in increased dose requirements for drugs that are primarily eliminated by renal excretion, including many antimicrobial agents and enoxaparin. Recognition of ARC is hampered by the fact that the standard creatinine-based equations used to estimate renal function are not accurate in this clinical setting and the diagnosis is best established using both serum and urine creatinine measurements to calculate clearance. So a high index of clinical suspicion and awareness is usually required before this step is taken to confirm the diagnosis of ARC.

Keyword

Antimicrobial agents; Augmented renal clearance; Critically ill patients; Drug dose requirements

MeSH Terms

Anti-Infective Agents
Creatinine
Critical Illness
Diagnosis
Enoxaparin
Humans
Renal Elimination
Anti-Infective Agents
Creatinine
Enoxaparin

Figure

• 

  Figure 1 Current understanding of the pathophysiology of ARC in which critical illness triggers the systemic inflammatory response syndrome (SIRS) or mobilizes renal functional reserve (RFR) to eventually increase renal blood flow and glomerular filtration rate (GFR). Intravenous fluids and drugs administered to critically ill patients may increase cardiac output and contribute to the increase in renal blood flow. Atrial natriuretic peptide (ANP) plasma concentrations are also elevated in patients with ARC and may play a role in increasing renal blood flow. (Modified from Sime FB, Udy AA, Roberts JA. Curr Opin Pharmacol 2015;24:1-6.)

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