WELCOME

To
My Presentation
 Presented To

Nadira Sultana Mirza

Adjunct Faculty

Department of English

Independent University,
Bangladesh
2
 I am….

Sumaya Akter Orna

ID-1930850

Section- 14

ENG-101

3
Movie Review
“Spotlight’’
 Presentation Docket

Introduction Measurement Of GFR

01 04

Cause Methods of Dose Adjustment

02 05

Classification References
03 06

6
 1
Introductio
n
“Spotlight” movie based on  Movie genre : Drama,
a true story. That’s why I Crime
watched this movie. Any Duration : 2hrs 9 min
good movie should move Release date : Nov
you emotionally. A great 25, 2015
movie will bring you to
Imdb Rating : 8.1/10
tears. “Spotlight” brought
 2
Summarize
 Spotlight follows the oldest
continuously operating
newspaper investigative unit in
America, The Boston Globe’s
“Spotlight” team. The true story
of how the Boston Globe
Spotlight uncovered the massive scandal of
child molestation and cover-up
within the local Catholic
Archdiocese, shaking the entire
Catholic Church to its core.
 “Robby” Robinson (Michael
Keaton), Michael Rezendes
(Mark Ruffalo), Sacha Pfeiffer
(Rachel McAdams), Marty Baron
(Liev Schreiber), Ben Bradlee Jr.
(John Slattery), and Matt Carroll
(Brian d’Arcy James). The focus
Spotlight of the movie is on the team’s
coverage of the sexual abuse
scandal in the Catholic
archdiocese of Boston,
Massachusetts.
 3
Actors/
Actresses
01
Acute renal
02
Failure Chronic Renal
Failure
13
 ARF is a rapidly progressive loss of
renal function, generally
characterized by oliguria (decreased
urine production) and fluid and

Acute renal DOSING ADJUSTMENT

electrolyte imbalance. OF ARF
Drug therapy optimization in ARF is a
Failure challenge confounding variables include
residual drug clearance , and fluid
accumulation.
Volume of distribution for water soluble
drugs is significantly increased due to
edema . Use of dosing guidelines for CKD
does not reflect the clearance and volume
 CKD is progressive loss of function
over several months to years ,
characterized by gradual
replacement of normal kidney

Chronic Renal architecture with interstitial

DOSING ADJUSTMENT IN CKD
fibrosis.
Failure  Loading doses do not need to be
adjusted in patients with CKD.
 Some guide lines suggest methods for
maintaining dosing adjustments: dose
reduction , lengthening the dose interval
or both.
 4
Measureme
nt of GFR
Measurement of
GFR

17
NATIONAL KIDNEY FOUNDATION KIDNEY DISEASE
OUTCOMES QUALITY INITIATIVE

GFR (mL per minute per

Stage Description 1.73 m2)

1. Kidney damage with normal or ≥90

increased GFR

2 Kidney damage with a mild 60 to 89

decrease in GFR

3 Moderate decrease in GFR 30 to 59

4 Severe decrease in GFR 15-29

5 Kidney failure < 15 (or dialysis)

CREATININE CLEARANCE

Creatinine clearance may be defined as the volume of plasma

cleared of creatinine per unit time .
It can be calculated by the following formula
Cl = 𝑟𝑎𝑡𝑒 𝑜𝑓 𝑢𝑟𝑖𝑛𝑎𝑟𝑦 𝑒𝑥𝑐𝑟𝑒𝑡𝑖𝑜𝑛 𝑜𝑓 𝑐𝑟𝑒𝑎𝑡𝑖𝑛𝑖𝑛𝑒/𝑠𝑒𝑟𝑢𝑚 𝑐𝑟𝑒𝑎𝑡𝑖𝑛𝑖𝑛𝑒 𝑐𝑜𝑛𝑐𝑒𝑛𝑡𝑟𝑎𝑡𝑖𝑜𝑛

 It describes ml/min .
Measure of GFR- creatinine clearance
 The clearance of creatinine is
used most extensively as a
measurement of GFR .
 Creatinine production varies
 Creatinine is an endogenous
with age, weight, gender of the
substance formed from creatinine
phosphate during muscle
individual.
metabolism.  In humans, creatinine is
filtered mainly at the
glomerulus, with no tubular re-
absorption.
 It tends to be decrease in
elderly patient.
 5
Methods Of Dosage
Adjustment
 The method of cockcroft and gault is
used to estimate creatinine clearance
from serum creatinine concentration
Cockcroft and  For males
Gault method 𝑐𝑙𝑐𝑟= 140−𝑎𝑔𝑒 𝑦𝑒𝑎𝑟𝑠 ×𝑏𝑜𝑑𝑦𝑤𝑒𝑖𝑔ℎ𝑡(𝑘𝑔) /72𝑐cr
 For females use 90% of the 𝑐𝑙𝑐𝑟 value
obtained in males.
 For Children
There are a number of methods for
calculation of creatinine clearance in
Cockcroft and children , based on body length , and

Gault method serum creatinine concentration.

 It is a method developed by
schwartzand associates :
𝑐𝑙𝑐𝑟= 0.55 𝑏𝑜𝑑𝑦 𝑙𝑒𝑛𝑔𝑡ℎ(𝑐𝑚) 𝑐𝑐𝑟
Where 𝑐𝑙 𝑐𝑟 is given in mL/min/1.73𝑚2
 The value 0.55 represents a factor used
for children ages 1 to 12 years
 Antihypertensive Agents:
Dosing Requirements in patients with Chronic Kidney Disease
 Antimicrobial Agents;
Dosing Requirements in patients with Chronic Kidney Disease
Add a full screen image

6
References
 National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney
disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39 (S1-266)
 Burkhardt H, Hahn T, Gretz N, Gladisch R. Bedside estimation of the glomerular
filtration rate in hospitalized elderly patients. Nephron Clin Pract 2005;101:c1-8.
 Bricker NS. On the meaning of the intact nephron hypothesis. Am J Med 1969; 46: 1–11.

28
Thank you!