Does Pulse Dosing of Methylprednisolone Have an Acute Effect on Serum Creatinine Concentrations?
Bibliographic record
Abstract
Pulse IV methylprednisolone therapy is the intermittent administration of supraphysiological quantities of the drug to enhance its therapeutic effects while reducing its toxic effects. 1 A typical pulse regimen ranges from 500 to 1000 mg IV daily for 2-4 consecutive days.1,2 It has been suggested that methylprednisolone may cause an acute increase in serum creatinine (SCr), which can be misinterpreted as a clinical indication of worsening renal function.3 A proposed mechanism for this effect is catabolic degeneration of protein and loss of muscle tissue induced by steroid therapy.3 However, the relation between pulse therapy and acute change in SCr after drug administration is not well defined.Sakemi and others 4 conducted a retrospective analysis of 56 patients with renal or collagen disease receiving 3 consecutive pulses of methylprednisolone 1000 mg IV daily.They found that the mean SCr increased significantly 1 day after the last dose and hypothesized that the observed effect depended on clinical status. 4 They speculated that the increase in SCr could have been due to baseline nephrosis and renal impairment, as opposed to the drug therapy.Liu and others 5 conducted a prospective study involving 49 patients with collagen vascular disease who received methylprednisolone 1000 mg IV daily for 3 consecutive days.In that study, there was no clinically significant change in SCr 1 day after the last dose.5 Other literature examining the relation between consecutive pulse doses of steroid and acute change in SCr after drug administration is limited, especially for patients without baseline renal impairment.Characterizing the acute effects of pulse dosing of methylprednisolone on SCr has important benefits.It will assist clinicians in determining whether patients who experience an increase in SCr have renal impairment, as opposed to a transient increase caused by the medication, thus avoiding unnecessary diagnostic or corrective interventions.A retrospective chart review was conducted for patients receiving pulse methylprednisolone for conditions in which renal impairment did not exist or was not anticipated from progression of disease at the time of treatment.All patients at 2 hospitals in Vancouver (St Paul's Hospital, a 500-bed tertiary care facility, and Mount Saint Joseph Hospital, a 100-bed community hospital) who received methylprednisolone 500-1000 mg IV daily for 2-4 consecutive days between July 1, 2009, and July 1, 2013, were considered for inclusion.The exclusion criteria were established renal impairment (SCr > 110 µmol/L or estimated glomerular filtration rate < 50 mL/min) before the first dose of
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".