Longterm cocaine use can lead to chronic renal failure. Renal dysfunction and renal disease due to drugs are common and can lead to renal failure, both acute and chronic. Abacavir abacavir lamivudine abacavir lamivudine zidovudine acarbose acebutolol acetaminophen acetazolamide acetohexamide acetohydroxamic acid acetylsalicylic acid aspirin acrivastine acyclovir adefovir adenosine albuterol inhaled albuterol oral alfentanil alfentanil allopurinol alprazolam alteplase tissuetype plasminogen activator. However, there are no robust methods for detection of hemodynamic changes that occur early in the course of renal injury including druginduced nephrotoxicity. Druginduced kidney disease free download as powerpoint presentation. Diseases and conditions that may slow blood flow to the kidneys and lead to kidney injury include. Recognizing the process as drug induced renal failure and stopping the drug is essential. Drug induced kidney disease can occur due to patient related factors and in specific disease table 1. Druginduced kidney diseases np singh, a ganguli, a prakash abstract druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. Druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. Acyclovirinduced acute renal failure and the importance. The renal proximal tubule is a main target for druginduced toxicity. Renal failure can occur as an acute or a chronic disorder. This syndrome is characterized by a sudden decrease in kidney function, with a conse.
Druginduced nephrotoxicity is caused by nephrotoxic drugs or toxins which damage kidneys and can lead to nephritis or renal toxicity. Druginduced acute renal dysfunction karen shalansky, pharm. You have free access to this content prescriber volume 17, issue 3, article first published online. Drug induced comprehensive textbook of nephrology, 2010. Update on new medications and unique mechanisms of nephrotoxicity. One can only speculate as to the reason why ranolazine caused pl in this patient. He was pale with skin ecchymosis over his thighs and was anaemic, with severe renal failure and metabolic acidosis. Druginduced kidney disorderdisease dkid is an origin of kidney disease followed by acute renal failure. Pepper professor of public health and preventive medicine professor of biostatistics and epidemiology, medicine, and pharmacology vice dean for institutional affairs university of.
Cocaine use can cause renal artery thrombosis clotting, severe hypertension and interstitial nephritis. Rare cases of renal failure and hemolytic reactions have been reported as separate side effects of oxaliplatin. Druginduced kidney disease pathology and current concepts. Druginduced heart failure may play a role in only a minority of the patients presenting with heart failure.
A 26yearold caucasian man with no medical history, except years of oral and intravenous drug abuse, presented with fatigue, shortness of breath, epistaxis and uncontrolled hypertension. Drugassociated renal dysfunction and injury nature. However, some reports suggest that between 5 and 20 per cent of cases of acute renal failure can be directly attributed to drugs and. Druginduced renal damage can be acute or chronic, prerenal, intrarenal vascular, tubular, glomerular or interstitial. The patient had been prescribed a rather low dose of the drug, and had not taken a larger dose than he was supposed to. Clinical pharmacology for the nephrologist khaled eldahshan, md lecturer of nephrology, mansoura. Crystalinduced acute renal failure crystalinduced acute renal failure perazella, mark a. Quizlet flashcards, activities and games help you improve your grades.
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. Druginduced nephrotoxicity tends to occur more frequently in patients with intravascular volume depletion, diabetes, congestive heart failure, chronic kidney disease, and sepsis. Acute kidney failure symptoms and causes mayo clinic. The type of renal failure is differentiated by the trend in the serum creatinine. Despite dramatic improvements in patient survival and drug tolerability, nephrotoxicity remains an important complication of chemotherapy. Nac is a relatively benign drug which can be given empirically, as it. Nephrolithiasis formation of renal calculi or kidney stones occurs as the result of abnormal crystal precipitation in the renal collecting system intratubular precipitation of crystallinematerial prevalence of drug induced nephrolithiasis is 1% signs and symptoms pain, haematuria, infection, or, occasionally, urinary. Acyclovirinduced acute renal failure, which is caused due to intratubular crystal precipitation has been well documented. Scribd is the worlds largest social reading and publishing site. However, all agents also carry adverse drug effect profiles.
Infants and young children with extracellular volume depletion, sepsis, renal impairment, cardiovascular disease, diabetes, or prior exposure to radio contrast agents are at risk of developing drug nephrotoxicity. Pharmaceutical agents provide diagnostic and therapeutic utility that are central to patient care. Use of aspirin, ibuprofen advil, motrin ib, others, naproxen sodium aleve, others or related drugs. Renal disease induced by drugs was studied by percutaneous biopsy in 40 patients. Drug induced kidney disease dikd clinical pharmacy by. Druginduced renal toxicity is more common in infants and young children in certain. To provide cutting edge care for these patients, nephrologists and oncologists must be familiar with the nephrotoxicity of these drugs.
Pharmacotherapeutic specialist, vgh clinical professor, ubc apr 8, 2010 outline pseudo renal failure acute renal failure prerenal nsaids, cyatacrolimus, aceiarb, diuretics intrinsic atn vs ain atn aminoglycosides, amphotericin b, radiocontrast media. Druginduced nephrotoxicity caused by amphotericin b lipid. In contrast, chronic renal failure is the end result of irreparable damage to the kidneys. Renal phospholipidosis possibly induced by ranolazine. Acute kidney injury and druginduced aki flashcards quizlet. The drug may be filtered or secreted into the lumen of the renal tubules. Druginduced impairment of renal function george sunny pazhayattil, anushree c shirali section of nephrology, yale university school of medicine, new haven, ct, usa abstract.
Druginduced acute renal hemodynamic dysfunction leads to renal tissue damage and further progression to renal failure 2,3. It develops slowly, usually over the course of a number of years. The prediction of proximal tubular toxicity during drug development remains difficult. Intratubular precipitation of these crystals can lead to acute renal insufficiency. Certain drugs can cause alteration in intraglomerular hemodynamics, inflammatory changes in renal tubular cells, leading to acute kidney injury aki, tubulointerstitial disease and renal scarring. Druginduced nephrotoxicity in adults is approximately 14%26% in prospective cohort studies of aki, whereas 16% of hospitalized aki is due to drugs in the pediatric population 14.
Druginduced kidney diseasealwin hl loh and arthur h cohen druginduced kidney disease pathology and current concepts alwin hl loh,1mbchbhons, frcpath, arthur h cohen,2,3md introduction departing from the usual account of druginduced renal disease according to the specific type of drug, we divide. Acute kidney injury and druginduced aki study guide by loretola includes 56 questions covering vocabulary, terms and more. In discussing druginduced renal impairment, it is helpful to recall that renal function is a composite of several steps which includes renal arterial blood flow, glomerular filtration, tubular fluid formation, and exit of urine into the urogenital system. Here we present a clinical picture of immunerelated intravascular hemolysis and acute tubular necrosis in a patient receiving this drug. If the drug is primarily cleared by the kidney, the drug will become increasingly concentrated as it is moves from the renal artery into the smaller vasculature of the kidney. Longterm tobacco use also increases the risk of kidney cancer. In conclusion, our patient with acute fulminant liver failure and acute renal failure made a full recovery. Prediction of druginduced nephrotoxicity and injury. Biomarkers have been identifi ed for the assessment of nephrotoxicity. 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. Druginduced renal disorders are more common in certain patients and in specific clinical situations. Nevertheless, druginduced heart failure should be regarded as a potentially preventable cause of heart failure, although sometimes other priorities do not offer therapeutic alternatives e.
Although each one of these drug categories can lead to renal failure, they are not, by themselves, as dangerous as when the three of them. Clinical evidence of aginduced acute tubular necrosis is seen within 5 to 10 days of initiation of ag treatment. Following initial clinical stabilisation of the patient, a renal biopsy was obtained, which. Drug induced kidney diseases authorstream presentation. Mechanisms for druginduced nephrotoxicity include changes in glomerular hemodynamics, tubular cell toxicity, inflammation, crystal nephropathy, rhabdomyolysis, and thrombotic microangiopathy. Recognizing the process as druginduced renal failure and stopping the drug is essential. The basis for a diagnosis of crystalinduced nephropathy is supported by the clinical history and time course of acyclovir administration. Druginduced nephrotoxicity tends to occur more frequently in patients with intravascular volume depletion, diabetes. Therefore, early detection of drugs adverse effects is important to prevent progression to endstage renal disease. C 7, 10, 32, 48 druginduced renal impairment is generally reversible, provided the nephrotoxicity is recognized early and the offending medication is discontinued. Druginduced renal disease, like other iatrogenic disorders, bedevils the patient and humbles the physician when he finds that he has done harm at the time he thought he was doing good. Ppt druginduced kidney disease powerpoint presentation. Chair and professor, department of biostatistics and epidemiology director, center for clinical epidemiology and biostatistics george s. Renal injury caused by medication can usually be reversed if detected early.
Retrospectively, cardiorenal syndrome due to restrictive cardiomyopathy was the cause of the patients acuteonchronic renal failure. Further research needs to be carried out on nacs role to neutralize nonacetaminophen drug. 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. Adverse renal effects occur because of innate drug toxicity and a number of patient and drugrelated factors. While most of these are clinically insignificant, some drugs.
Full text druginduced impairment of renal function ijnrd. Drugs with low solubility may form crystals, causing obstruction of urine output and subsequent renal failure. Nsaids each year, up to 5% of people who take nsaids will develop renal toxicity, resulting in hospital admissions and an increase in health care spending. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain stereotyped renal responses. Injury patterns subtle injury or overt renal failure some drugs perturb renal perfusion and induce. Druginduced nephrotoxicity is more common in hospitalized patients, in. Crystalinduced acute renal failure, the american journal. Nsaidcoxib induced hemodynamic renal failure nsaids causes hemodynamic acute renal failure due to inhibition of the synthesis of vasodilatory prostaglandins which are mainly contributing the vasodilation of afferent arterioles for normal maintenance of gfr cox2. Druginduced renal failure is a wellrecognised phenomenon, although the incidence of druginduced renal disease remains uncertain. Druginduced nephrotoxicity caused by amphotericin b lipid complex and liposomal amphotericin b.
Aginduced acute renal failure is generally nonoliguric, and may be associated with decreasedurineconcentratingabilityand urinary magnesium wasting. Oxaliplatin is an effective chemotherapeutic agent frequently used in the treatment of colorectal carcinoma. Features and management of druginduced renal failure. Infants and young children with extracellular volume depletion, sepsis, renal impairment, cardiovascular disease, diabetes, or prior exposure to radio contrast agents are. The causative drug must be identified and its use must be.
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