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  Kidney disease is a major cause of death and disability in many countries around the world. for example, in 2009, over 26 million adults in the United States are estimated to have chronic kidney disease, and more than millions of others who experienced acute renal failure or renal dysfunction milder form of the other. General description of the kinetics of drug All drugs, except those injected intravenously, should be in absorption from the site of administration (gut, skin, or muscle) into the blood and walked to the location kerjannya. Most oral medications are absorbed in the small intestine. Some drugs undergo first pass metabolism in which drug metabolism or inactivation in the liver, or more rarely in the gut or the lung, before the drug reaches the systemic circulation. Once in absorption, drug distribution are scattered throughout the volume, which can only involve a particular tissue. Many drug plasma protein binding, albumin binds acidic drugs, and alpha-1 acid glycoprotein drug binding alkaline. Drugs that bind strongly with plasma proteins is likely to persist in the circulation. If a bond with a low protein drug distribution depends on lipid solubility. Drugs were dissolved in water to survive in the extra cellular fluid, while the fat-soluble drugs get into the cells and can even be concentrated in fatty tissue. Many drug excretion by the kidneys, and can accumulate to toxic levels if there is renal impairment. Handling Medication in Kidney Drugs that bind to plasma proteins is not in filtration, because the protein is not in filtration. Filtration drugs that do not bind to the protein depends on the size and charge. Organic anion and cation transporters in the proximal tubule can secrete drugs and can be saturated. Tubular reabsorption of the drug did not play a major role. prescribe drugs excreted by the kidneys drug excretion by the kidneys showed kinetics first degree. this means that the rate of drug release is proportional to the concentration of drug in plasma. after administration of a single dose, the plasma levels increased, reaching a peak, and decline. time is the time it takes half of peak levels until it reaches half. with a stable dose (Steady), to the required four times the half time to reach steady state (steady state). dose equal to the amount of drug in the body in a steady state will eliminate this delay. hence, a maintenance dose of half the loading dose and is given once every half time. volume of distribution is calculated by dividing the amount of drug given to its concentration in plasma. to reach measurable levels in plasma, the drug should be spread evenly within the plasma volume. levels at steady state increases with increasing dose, dose frequency, or half the time of drug absorption, and decreased volume of distribution.  prescribing in renal impairment renal impairment reduces glomerular filtration and tubular secretion of the drug. drug doses are usually affected when more than 50% of normal drug elimination is done by the kidneys. to avoid toxicity, the dose should be reduced or enhanced administration interval. if necessary, medication levels monitored. most of polypeptide hormones, including insulin and parathyroid hormone, is metabolized in the kidneys and bersihannya reduced in renal impairment circumstances. in chronic kidney disease, the binding protein in acidic drug (such as phenytoin and theophylline) because the toxin urea berkuranf compete seize drug binding sites on albumin. otherwise binding protein in drug bases will be increased in patients with uremia due to alpha-1 acid glycoprotein levels increase.
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