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Insuficiência renal que requer alteração da dose: moderada (CrCl 30-50 ml/min) ou grave (C...

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IDRF-ORGAN-RENAL-IMPAIRED
TipoSinal de alerta
Estadoreviewed 2026-04-27 | pending_clinical_signoff
DoençasNenhuma declaração
FontesSRC-ESMO-DLBCL-2024 SRC-NCCN-BCELL-2025

Origem da bandeira vermelha

DefiniçãoRenal impairment requiring dose modification: moderate (CrCl 30-50 mL/min) or severe (CrCl <30 mL/min). Affects renally cleared cytotoxics and targeted agents — cisplatin (severe contraindicated; use carboplatin with Calvert formula), carboplatin (AUC dosing), HD-MTX (contraindicated CrCl <50), HD-cytarabine, cyclophosphamide (25-50% reduction), bleomycin (50% reduction), capecitabine, lenalidomide, gemcitabine.
Direcção clínicade escalonamento
Categoriadisfunção de órgãos

Lógica de Desencadeamento

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 50
    }
  ],
  "type": "lab_value"
}

Notas

Single trigger covers both moderate (30-50) and severe (<30) — engine consumers should branch on the actual finding value to apply the correct attenuation. Per NCCN Drug Renal Dosing Tables / ASCO expert-panel 2014 (Lichtman et al.): cisplatin contraindicated CrCl <30 (substitute carboplatin Calvert AUC 4-5); HD-MTX contraindicated <50 mL/min (substitute IT MTX for CNS prophylaxis); cyclophosphamide reduce 25% at CrCl 30-50, 50% at <30; lenalidomide 10 mg (vs 25 mg) at CrCl 30-60, 15 mg q48h <30, dialysis-specific dosing. Anti-CD20 monoclonals (rituximab, obinutuzumab) and BTKi do not require renal adjustment. Multiple myeloma RF-MM-RENAL-DYSFUNCTION already exists for myeloma-specific cast-nephropathy logic.

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