• Korean Journal of Clinical Pharmacy
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• v.22 no.3
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• pp.220-227
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• 2012

Kidney and liver are the major organs of metabolism and excretion of drugs. Renal and Hepatic impairment may affect the pharmacokinetics/pharmacodynamics and the safety of drugs. Adjusting the dosage based on organ function is the essential role of pharmacists. However, differences have been noted on the recommended dosage among the literatures. We compared and analyzed the recommendations of 4 literature sources which are commonly used for dosage adjustment. From April, 2011 to August, 2011, we selected data on recommendations for dosage adjustment for impaired renal and hepatic function of 100 drugs through a protocol. We analyzed the definition terms of renal and hepatic impairment, recommendations for dosage adjustment, evidenced references in four literature sources: Korean National Formulary (KNF), American Hospital Formulary System Drug Information (AHFS), Micromedex (MM) and Drug Prescribing of Renal Failure (DPRF). We further examined the data homogeneity by comparing how drugs that required no adjustment according to one source were categorized by the other. Sources use different definition terms among themselves except DRPF. Presence or absence of evidenced references about renal/hepatic functional states are KNF (0%/0%), AHFS (78%/62.6%), MM (87.5%/65.6%) and DPRF (93.2%/no recommendation) respectively. Recommendations of specific dosage and dosing interval are KNF (24%/13%), AHFS (39.6%/12.1%), MM (50%/17.7%), and DPRF (55.4%/no recommendation) respectively. Regarding the data homogeneity, the differences were remarkable. Drugs with no adjustment according to AHFS were categorized to be adjusted/ contraindicated by KNF, MM, DPRF and the values were (44%/5.6%), (22%/0%), and (36%/0%) in renal function, (39%/6.5%), (19%/3.2%), and (no recommendation/no recommendation) in hepatic function respectively. Our study shows remarkable definite variation in definitions and recommendations about definition terms, information of dosage and interval, presence or absence of evidenced references. Especially for KNF, quantitative recommendations on dosages and dosing intervals should be made in the near future. To maximize the drug effect and safety and to minimize the heterogeneity of the literature sources, reviewing at least two sources are suggested when recommending the proper dosage adjustment based on organ function.

• Biomedical Science Letters
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• v.24 no.4
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• pp.411-417
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• 2018

The aim of this study was to investigate the impact of participation in the 622 km hyper-ultra-marathon on hepatic metabolism and renal function in middle-aged men. Healthy middle-aged male amateur ultra-marathoners between the ages of 40 and 60. Blood was collected at the pre-race, immediately after 300 km, 622 km hyper-ultra marathon race, 72 hours (3 day) and 144 hours (6 day) after the race, AST (aspartate aminotransferase), ALT (alanine aminotransferase), ALP (alkaline phosphatase), ${\gamma}$-GTP (gamma glutamyl transferase), T-Bil (total bilirubin), D-Bil (direct bilirubin), T-protein (total protein), albumin, uric acid, BUN (blood urea nitrogen), creatinne were analyzed. ALP was significantly increased at 300 km, 622 km, day 3 and day 6 than the pre-race. ${\gamma}$-GTP, T-protein, albumin, uric acid, BUN and creatinine were not significantly different between the distances and the recovery period respectively. AST and ALT were significantly increased at 300 km, 622 km, day 3 and day 6 than the pre-race, respectively (P<0.05) at day 3 and day 6 they showed significant decrease from 300 km and 622 km, respectively (P<0.05). T-Bil and D-Bil increased significantly at 300 km and 622 km, respectively (P<.05) and significantly decreased at day 3 (P<0.05) compared to the pre-race, at day 3 and day 6 they were decreased significantly than 300 km and 622 km, respectively (P<0.05). In conclusion, no disturbance of renal function was observed according to the distances and between the recovery period of 622 km hyper-ultra marathon race, but reversible hepatocyte function could be degraded and some hemolysis of blood vessels was induced.

• Journal of Korean Medical Science
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• v.33 no.53
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• pp.298.1-298.10
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• 2018

Background: The renal function of individuals is one of the reasons for the variations in therapeutic response to various drugs. Patients with renal impairment are often exposed to drug toxicity, even with drugs that are usually eliminated by hepatic metabolism. Previous study has reported an increased plasma concentration of indoxyl sulfate and decreased plasma concentration of $4{\beta}$-hydroxy (OH)-cholesterol in stable kidney transplant recipients, implicating indoxyl sulfate as a cytochrome P450 (CYP) inhibiting factor. In this study, we aimed to evaluate the impact of renal impairment severity-dependent accumulation of indoxyl sulfate on hepatic CYP3A activity using metabolic markers. Methods: Sixty-six subjects were enrolled in this study; based on estimated glomerular filtration rate (eGFR), they were classified as having mild, moderate, or severe renal impairment. The plasma concentration of indoxyl sulfate was quantified using liquid chromatography-mass spectrometry (LC-MS). Urinary and plasma markers ($6{\beta}$-OH-cortisol/cortisol, $6{\beta}$-OH-cortisone/cortisone, $4{\beta}$-OH-cholesterol) for hepatic CYP3A activity were quantified using gas chromatography-mass spectrometry (GC-MS). The total plasma concentration of cholesterol was measured using the enzymatic colorimetric assay to calculate the $4{\beta}$-OH-cholesterol/cholesterol ratio. The correlation between variables was assessed using Pearson's correlation test. Results: There was a significant negative correlation between MDRD eGFR and indoxyl sulfate levels. The levels of urinary $6{\beta}$-OH-cortisol/cortisol and $6{\beta}$-OH-cortisone/cortisone as well as plasma $4{\beta}$-OH-cholesterol and $4{\beta}$-OH-cholesterol/cholesterol were not correlated with MDRD eGFR and the plasma concentration of indoxyl sulfate. Conclusion: Hepatic CYP3A activity may not be affected by renal impairment-induced accumulation of plasma indoxyl sulfate.

• Clinical and Experimental Pediatrics
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• v.45 no.7
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• pp.923-927
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• 2002

Congenital hepatic fibrosis is a relatively rare disease, characterized by bile ductular proliferation and prominent fibrosis in the portal area of liver resulting in portal hypertension. It is frequently associated with other abnormalities such as polycystic kidney, Caroli syndrome, cystic dysplasia of pancreas, intestinal lymphangiectasia, pulmonary emphysema, hemangioma, and cleft palate. We report here a case of congenital hepatic fibrosis associated with renal tubular ectasia in a 3-year-old girl, whose chief complaint was abdominal distension. Her liver function test did not reveal any abnormal findings. Hepatosplenomegaly and multiple dilated bile ducts were seen in the abdominal CT scaning. Esophageal varix was not detected by an endoscopic examination. Microscopically, diffuse portal fibrosis and widening with proliferation of blie ductules in the liver specimen and tubular ectasia in renal cortex were seen.

• Asian-Australasian Journal of Animal Sciences
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• v.10 no.3
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• pp.260-264
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• 1997

This study was conducted with adult cockerels to determine whether dietary RNA affects feed intake and renal weight and function, and if the responses are similar to dietary adenine. Chickens were ad libitum fed a RNA diet (100 g/kg) or an adenine diet (9.1 g/kg) for 14 d and catheterized in right jugular vein, hepatic portal vein and both urethers, and saline together with para-amino hippuric acid and sodium thiosulfate was continuously infused into them to evaluate renal functions. Dietary RNA reduced feed intake and body weight, and dietary adenine increased kidney weight expressed as a proportion of body weight (P < 0.05). Feed intake and body weight on the adenine diet and kidney weight on the RNA diet showed similar though non significant tendencies. No calculi were detected in the kidney in chickens fed either the RNA or adenine diets. Plasma inorganic phosphate (IP), Ca and 1,25 $(OH)_2$ vitamin $D_3$ concentrations were increased by dietary RNA and adenine, although the increases of IP and Ca in adenine-fed chickens were not significant. Uric acid and urea concentrations in the blood plasma were unaffected by dietary RNA or adenine. Both dietary RNA and adenine increased renal blood flow rates 3.5-3.7 fold, renal plasma flow rates 3.4-3.7 fold and glomerular filtration rates (GFR) 2.9-3.0 fold (p < 0.01). Clearance of urea, IP and Ca were also enhanced by dietary RNA, but not by dietary adenine. However, neither RNA nor adenine affected uric acid clearance. Only IP clearance was significantly augmented at the glomerular level by dietary RNA (p < 0.05). Glomerular filtration of uric acid, urea, IP and Ca and reabsorption of urea, IP and Ca at the renal tubule were increased by dietary RNA and adenine (p < 0.05), whereas tubular secretion of uric acid was decreased by both dietary treatments. It is concluded that dietary adenine is effective in changing renal function and P and Ca metabolism in chickens.

• Journal of Chest Surgery
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• v.7 no.1
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• pp.73-78
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• 1974

Influences on organ function were studied in animals during prolonged extracorporeal circulation with a bubble type of oxygenator. More than six hours of total cardiopulmonary bypass was performed under mild hypothermia by means of an extracorporeal circulation system in five dogs. Obtained results were summarized as follows. 1. The renal function was not so impaired seriously until four hours of extracorporeal circulation. However, there was more serious impairment of renal function in this study when extracorporeal circulation was carried out for a period of five hours or more. 2. There was gradual hepatic damage during extracorporeal circulation and the damage was more significant after bypass for a period of five to six hours. 3. There was a significant decrease in serum K during bypass, irrespective of the pump oxygenator prime with a high K solution. The reason for this is complex and due to many factors, however, it was evidently related to serum glucose levels during extracorporal circulation.

• Journal of Veterinary Clinics
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• v.21 no.1
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• pp.66-71
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• 2004

2 Cases of nephrotomy for removal of calculi in dog were referred to veterinary teaching hospital of Konkuk University. In case 1, a 5 year-old, castrated male Yorkshire Terrier dog was referred because of intermittent hematuria, pain in urination for one month. Hematologic and chemical examination showed mild increased BUN and CPK. Radiographic findings revealed radiopaque materials in the urinary bladder, urethra, and left kidney. Retrograde hydropropulsion was performed to move the calculi into the bladder, and cystotomy was done to remove calculi. Nephrotomy was performed to removal of the calculi from the left renal pelvis and calyx. After operation renal function were recovered and preserved. In case 2, a 5 year-old, neutral female Schnauzer dog was referred because of persistant vomiting, anorexia, and celialgia for 20 days. Hematologic and chemical examination showed stress leucogram, moderate azotemia, hypercalcemia, hyperphosphatemia, and increased ALP. Radiographic findings revealed enlargement of the left kidney and radiopaque materials in the both of the kidneys. On excretory urography, left kidney was no pyelogram. On ultrasonography, renal tissue was very thin and distended renal pelvis appeared. Nephrectomy of nonfunctional left kidney and nephrotomy for removal of calculi from the right renal pelvis and calyx were done. One week after operation, renal and hepatic functions were recovered. So, in cases of renal calculi, it is necessary that renal calculi are extracted actively as far as the patient's body condition endurable.

• Nutrition Research and Practice
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• v.12 no.6
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• pp.535-540
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• 2018

BACKGROUND/OBJECTIVES: Propolis has a rich source of bioactive compounds and has renal and hepatic protective properties. The purpose of this study was to investigate the beneficial effect of hydro-ethanolic extract of propolis against paracetamol-induced liver damage and impairment of kidney function, as well as hematological changes in rats. MATERIALS/METHODS: Six groups of rats were used; the first group was served as a control; the second and third groups were treated by propolis extract at a dose of 50 and 100 mg/kg.B.WT. respectively; the fourth group was treated by paracetamol (200 mg/kg.B.WT.); the fifth group was treated by propolis (50 mg/kg.B.WT.) for eight days and then received similar dose of propolis for following seven days with paracetamol at a dose of 200 mg/kg.B.WT. daily for the seven days; and the sixth group was treated with propolis (100 mg/kg.B.WT.) for eight days and then received similar dose of propolis for following seven days with paracetamol at a dose of 200 mg/kg.B.WT. daily for the seven days. All the animals were treated for a period of 15 days. At the end of the experimental period, blood samples were collected for measurement of the liver enzymes, serum albumin, protein and creatinine, blood urea nitrogen, hematological parameters, and urine volume, protein and albumin. RESULTS: Paracetamol over dose significantly lowered hemoglobin, serum total protein, albumin, and uric acid, while it significantly increased blood creatinine, blood urea nitrogen, alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase activities, white blood cells, and platelet count as compared to the control. However, these alterations were significantly attenuated by the use of propolis extract and the effect was dose dependent. Interestingly, propolis prevented paracetamol induced proteinuria, low hemoglobin and body weight loss. CONCLUSIONS: Propolis significantly prevented paracetamol induced renal, hepatic and hematological toxicity and might be useful in the management of liver and renal diseases particularly proteinuria.

• Journal of Environmental Health Sciences
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• v.22 no.4
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• pp.91-101
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• 1996

Exposure indices are important tools which enable scientists to reliably predict and detect exposures to xenobiotics and resultant cell injury. Since the de novo synthesis of stress proteins can be detected early after exposure to some agents, analysis of toxicant-induced changes in gene expression, i.e. alterations in patterns of protein synthesis, may be useful to develop as biomarkers of exposure and toxicity. The acute and chronic effects of cadmium(Cd, $CdCl_2$ 20 mg/kg) on Wistar male rats were evaluated concerning cadmium contents, tissues enzyme activity, HSP expression. The results of the study were as follows: 1. Less cadmium was absorbed through the digestive tracts, but the ratio of contents in renal to hepatic cadmium was higher at 8 weeks after treatment. 2. ALT(alanine aminotransferase), AST(aspartate aminotransferase), glucose, BUN(blood urea nitrogen), creatinine, the key indices of the clinical changes in hepatic and renal function were significantly changed by the cadmium treatment after 1 week in liver, after 4 weeks in kidney. 3. Enhanced synthesis of 70 KDa relative molecular mass proteins were detected in 2 hours after cadmium exposure, with maximum activity occurring at 8~48 hours. Induction of $HSP_{70}$ was evident at proximal tubules and glomeruli in kidney. Testicular cells produced enough HSP to be detected normally. From the above results, it could be concluded that $HSP_{70}$ induction by the cadmium treatment was a rapid reaction to indicate the exposure of xenobiotics.

• The Korean Journal of Physiology and Pharmacology
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• v.17 no.2
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• pp.169-173
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• 2013

Renal ischemia-reperfusion (IR) causes remote liver damage. Oxytocin has anti-inflammatory and antioxidant effects. The main purpose of this study was to evaluate the protective function of oxytocin (OT) in remote liver damage triggered by renal IR in rats. Twenty four rats were randomly divided into four different groups, each containing 8 rats. The groups were as follows: (1) Sham operated group; (2) Sham operated+OT group (3) Renal IR group; (4) Renal IR+OT group. OT ($500{\mu}g/kg$) was administered subcutaneously 12 and 24 hours before and immediately after ischemia. At the end of experimental procedure, the rats were sacrificed, and liver specimens were taken for histological assessment or determination of malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS), paraoxonase (PON-1) activity and nitric oxide (NO). The results showed that renal IR injury constituted a notable elevation in MDA, TOS, Oxidative stress index (OSI) and significantly decreased TAS, PON-1 actvity and NO in liver tissue (p<0.05). Additionally renal IR provoked significant augmentation in hepatic microscopic damage scores. However, alterations in these biochemical and histopathological indices due to IR injury were attenuated by OT treatment (p<0.05). These findings show that OT ameliorates remote liver damage triggered by renal ischemia-reperfusion and this preservation involves suppression of inflammation and regulation of oxidant-antioxidant status.