Paeds Cases · clinical-pharmacology-and-therapeutics
Renal and hepatic dose adjustment OSCE — child with CKD, a high-risk antibiotic and family counselling
Observed structured encounter testing bedside Schwartz eGFR calculation, KDIGO staging, a renal dose-adjustment decision for a high-risk antibiotic, level interpretation, and family counselling on a non-standard dose.
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RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A 9-year-old with known CKD is admitted with a urinary tract infection and needs a renally cleared antibiotic. The candidate must calculate the eGFR, stage the kidney, make a dose-adjustment decision, interpret a drug level, and explain the non-standard dose to the family.
Candidate brief
- Calculate the child's estimated GFR using the bedside Schwartz equation and state the KDIGO category. [1] [4]
- Decide how to adjust the antibiotic dose for her renal function, including the loading dose and the maintenance strategy. [5]
- Interpret the drug level and state your next action. [7]
- Explain the non-standard dose to her mother in language she can repeat back. [5]
References6ShowHide
- [1]Schwartz GJ, et al New equations to estimate GFR in children with CKD J Am Soc Nephrol, 2009.PMID 19158356
- [4]Stevens PE, et al Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline Ann Intern Med, 2013.PMID 23732715
- [5]Verbeeck RK, et al Pharmacokinetics and dosage adjustment in patients with renal dysfunction Eur J Clin Pharmacol, 2009.PMID 19543887
- [7]Rybak MJ, et al Therapeutic monitoring of vancomycin for serious MRSA infections: a revised consensus guideline Am J Health Syst Pharm, 2020.PMID 32191793
- [11]Holsteen PE, et al Nephrotoxic Exposures and Acute Kidney Injury in Noncritically Ill Children Stratified by Service Hosp Pediatr, 2022.PMID 36102129
- [10]Soeorg H, et al Pharmacokinetics of Gentamicin Components C1, C1a, and C2/C2a/C2b and Subsequent Decline in Glomerular Filtration Rate in Neonates AAPS J, 2022.PMID 35760955