Nephrotoxins and drugs in renal insufficiency

Renal insufficiency induces profound pharmacokinetic and pharmacodynamic changes. The widespread reporting of estimated glomerular filtration rate (eGFR) has alerted clinicians to the incidence of renal insufficiency and the need for drug dose amendment. For drugs with a high therapeutic index, the eGFR can be used as a guide to dose adjustment. However, for drugs with a low therapeutic index, pending further experimental data relating drug excretion to the modification of diet in renal disease (MDRD) determination of eGFR, the Cockcroft and Gault equation using the patient's ideal body weight is the most reliable way to determine dose adjustment.