Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes disorders. Hypertension following unilateral renal irradiation. This new edition features brandnew guidance on pediatric dosing, making it the most complete resource of its kind. Druginduced impairment of renal function george sunny pazhayattil, anushree c shirali section of nephrology, yale university school of medicine, new haven, ct, usa abstract. Acute kidney injury may increase the risk for chronic kidney disease and endstage renal. Although the diagnosis of ckd is now quite straightforward, the proportion of patients with endstage renal disease seen by a nephrologist. Your doctor determines your stage of kidney disease based on the presence of kidney damage and your glomerular filtration rate gfr, which is a measure of your level of kidney function. Causes and prognosis t here are many causesmore than fifty are given within this present chapterthat can trigger pathophysiological mechanisms leading to acute renal failure arf. The condition can be costly and may require multiple interventions, including hospitalization. Full text druginduced impairment of renal function ijnrd.
This is also valid for the hypertensive ckd that occurs after hsct 4,21. Renal failure can occur as an acute or a chronic disorder. Details the biochemical and physiological effects of drugs in patients with renal failure, emphasizes those medications eliminated by the kidney as well as the importance of the patients glomerular filtration rate gfr. Diagnosis of druginduced liver diseases can be difficult, but the key to causality is to diligently exclude other causes of liver injury, and to identify a characteristic clinical drugrelated signature. The presence of lvh is associated with decreased survival of patients on dialysis. Pharmaceutical agents provide diagnostic and therapeutic utility that are central to patient care. Kidney failure is classified as either acute kidney failure, which develops. In a case of undiagnosed renal disease a possibility of druginduced renal failure should be kept as the prompt removal of the drug and supportive management can reverse the renal dysfunction to a. Diagnosis, management and prevention of druginduced liver. If the transplant works well the person will no longer need dialysis. Your treatment is based on your stage of kidney disease.
This process is experimental and the keywords may be. Druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Druginduced renal disease diagnostic histopathology. It develops slowly, usually over the course of a number of years.
Table 1 renal complications of nonsteroidal antiinflammatory drug use. The worldwide incidence of renal side effects is reported to be around 1%5%. This results in electrolyte and acidbase abnormalities and retention of nitrogenous waste products, such as urea and creatinine. However, all agents also carry adverse drug effect profiles. In contrast, chronic renal failure is the end result of irreparable damage to the kidneys. However, some reports suggest that between 5 and 20 per cent of cases of acute renal failure can be directly attributed to drugs and. Management of druginduced liver injury is symptomatic, with early referral to a. At present, chronic kidney disease ckd is broadly defined on the basis of changes in the glomerular filtration rate andor the presence of parenchymal damage present for at least 3 months. Drugassociated renal dysfunction and injury nature. This syndrome is characterized by a sudden decrease in kidney function, with a conse. Trends in acute renal failure inpatient stays are presented from 2005 to. Druginduced nephrotoxicity is a common problem in clinical medicine and the incidence of drugrelated acute kidney injury aki may be as high as 60 percent 14.
As a result, ex cretion of nitrogenous wastes is reduced and fluid and. Drug prescribing in renal failure r2 digital library. Acute renal failure is abrupt in onset and often is reversible if recognized early and treated appropriately. However, other studies have shown close correlation between degree of azotemia and prevalence of hypertension 1. Pdf nonsteroidal antiinflammatory drug induced acute. Drug induced kidney disease can occur due to patient related factors and in specific disease table 1. The term aki has replaced acute renal failure because smaller changes in kidney function without overt fail ure can result in significant clinical consequences and. Generating an epub file may take a long time, please be patient. Indexed in medline, thomson reuters journal citations reports and scopus, this open access journal publishes research on acute renal injury and its consequence, as well as addressing advances in the fields of chronic renal failure, hypertension, and renal transplantation.
Renal dysfunction and renal disease due to drugs are common and can lead to renal failure, both acute and chronic. Pdf how to prevent, recognize, and treat druginduced. Nonsteroidal antiinflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease. Druginduced renal failure is a wellrecognised phenomenon, although the incidence of druginduced renal disease remains uncertain. For most people with kidney failure having a kidney transplant is the best treatment. Public health renal failure these keywords were added by machine and not by the authors. In acute renal failure the glomerular filtration rate gfr is decreased. Rhabdomyolysis is the main cause responsible for renal injury. The causes of acute renal failure com monly are categorized as prerenal 55% to 60%, postrenal. Several can cause acute kidney injury aki, which can initiate or accelerate chronic kidney disease ckd progression. Mycophenolate mofetil prevents the progressive renal failure induced by 56 renal ablation in rats.
Older age 7, 8 and underlying chronic kidney disease are also related to the onset of aki during nsaid use, with early studies showing that the risk of deterioration in renal function increases 34 fold in patients with abnormal baseline renal function compared to those with normal renal function 9. Physiopathologic effects include hemodynamic alterations, failure in the synthesis of glomerular matrix, degradation and oxidative stress and induced renal atherogenesis. Acute renal failure and other complications induced by. Nsaids can result in a variety of renal complications table 1. Drug induced pseudorenal failure bun due to protein catabolism steroids, tetracyclines scr due to competitive inhibition of creatinine secretion trimethoprim, cimetidine, triamterene with trimethoprim 1535% rise scr fully expressed after 3 days more sig in pts with preexisting renal dysfunction can. Acute and chronic renal failure are the two kinds of kidney failure. The incidence of acute kidney injury aki has been increasing over time. The combination of loop and thiazide diuretics, often used to treat volume overload of heart failure, nephrotic syndrome andor chronic renal failure, is one example. Kidney failure, also known as endstage kidney disease, is a medical condition in which the kidneys are functioning at less than 15% of normal.
Patients at highest risk of druginduced nephrotoxicity are those with one or more of the following. Acute renal failure can be caused by several types of conditions, including a decrease in blood. Current information suggests that arf accounts for 1% of hospital admissions, implicating occurrence in the outpatient setting, and occurs in 2% to 5% of inhospital patients. Acute renal failure arf is defined as a rapid loss of renal function due to damage to the kidneys. This article provides a summary of the most common mechanisms of druginduced nephrotoxicity and prevention strategies. Nonsteroidal antiinflammatory drug induced acute kidney.