|Home | About | Journals | Submit | Contact Us | Français|
In the western world acute kidney injury is probably most commonly caused by ischemia and renovascular disease in older patients. In Asia and Africa toxin ingestion and the more exotic causes like snake bite are much more common. Whatever the cause early detection of the renal injury is paramount and creatinine is not the ideal biomarker. Mohamed Fahim and colleagues review this field and cover the causes of acute kidney injury (including frightening species like the hump-nosed pit viper or good old paraquat) the pathophysiology and the biomarkers. Ultimately this should also lead to better outcomes.
One intoxication that occurs frequently in the developed world is paracetamol overdose. The overdose can be treated reasonably well with N-acetylcysteine, but who should be treated? Nick Bateman knows this area probably better than anyone and describes what happens when the decision criteria in the traditional nomograms are changed. A much better approach would be to use modern biomarkers of liver injury like the micro RNA miR 122 in addition to the plasma concentration to get a better risk profile.
Pharmacokinetic dynamic modelling is often used as a retrospective analysis tool to describe complicated data sets but the models are of course intended to predict the future. This is not often done but Markus Joerger and his team use a model they created for the topoisomerase I inhibitor namicetan (a relative of irinotecan) with potentially improved physicochemical properties. The dose limiting myelosuppression could be predicted by the model. Because of this they could investigate different dosing schedules and select the most appropriate without exposing a single patient. The much loved body surface area as the driver for dose in oncology was yet again found useless.
PET imaging is very important for the determination of receptor occupancy in the human and animal brain. To obtain information about this quite a bit of mathematical modelling is involved. The Simplified Reference Tissue model (SRTM) is often used but requires certain assumptions about non-displaceable binding in different brain regions. Matts Kagedal from the group of Mats Karlsson in Uppsala describes a novel extended model.
In BJCP we publish the high tech stuff from innovative pharmacological research. Of course these innovation have to ultimately benefit patients all over the world. Pharmacogenetics of HIV compounds have this potential. Phumla Sinxadi and colleaugues made the connection between HIV treatment with efavirenz and a new CYP 2B6 polymorphism (15582C ->T). They studied this in South African adults and children in the population where it matters because precise dosing prevents emergence of resistance and long-term adverse events.