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In pharmacology, augmented renal clearance (ARC) is a phenomenon where certain critically ill patients may display increased clearance of a medication through the kidneys. In many cases, it is observed as a measured creatinine clearance above that which is expected given the patient's age, gender, and other factors.
Over 90% of the dose is excreted in the urine, therefore there is a risk of accumulation in patients with renal impairment, so therapeutic drug monitoring (TDM) is recommended. [citation needed] Oral preparations of vancomycin are available, however, they are not absorbed from the lumen of the gut, so are of no use in treating systemic infections.
Vancomycin is recommended to be administered in a dilute solution slowly, over at least 60 min (maximum rate of 10 mg/min for doses >500 mg) [21] due to the high incidence of pain and thrombophlebitis and to avoid an infusion reaction known as vancomycin flushing reaction. This phenomenon has been often clinically referred to as "red man syndrome".
For example, gentamicin is an antibiotic that can be nephrotoxic (kidney damaging) and ototoxic (hearing damaging); measurement of gentamicin through concentrations in a patient's plasma and calculation of the AUC is used to guide the dosage of this drug. [3] AUC becomes useful for knowing the average concentration over a time interval, AUC/t.
In these cases, clearance is almost synonymous with renal clearance or renal plasma clearance. Each substance has a specific clearance that depends on how the substance is handled by the nephron. Clearance is a function of 1) glomerular filtration , 2) secretion from the peritubular capillaries to the nephron , and 3) reabsorption from the ...
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The «renal clearance» rate will be determined by factors such as the degree of plasma protein binding as the drug will only be filtered out if it is in the unbound free form, the degree of saturation of the transporters (active secretion depends on transporter proteins that can become saturated) or the number of functioning nephrons (hence ...