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. 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. In this study, we show a case of probably tmp smx induced acute renal failure in a patient with early chronic kidney disease ckd. Therefore, early detection of drugs adverse effects is important to prevent progression to endstage renal disease. We report a case of ciprofloxacin induced acute nonoliguric renal failure that developed in a patient with chronic glomerulonephritis. 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 obstructive. Pdf on aug 1, 1996, c j lote and others published mechanisms of acute renal failure find, read and cite all the research you need on researchgate.
Certain drugs can cause alteration in intraglomerular hemodynamics. Drug dosing adjustments in patients with chronic kidney disease myrna y. Acute renal failure with zoledronate in mm has only been reported by a few authors as sporadic cases 1618. This syndrome is characterized by a sudden decrease in kidney function, with a conse. Nephrotoxic acute renal failure arf is a major cause of arf in hospitalized patients, accounting for 2030% of arf episodes 1, 3. Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes disorders. Renal disease 1 acute renal failure learning article. Trimethoprimsulfamethoxazoleinduced acute renal failure. Schrier department of medicine, university of colorado schoolofmedicine, denver, colorado several studies have shown that acute renal failure. Drug induced kidney diseases np singh, a ganguli, a prakash abstract drug induced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. Jun 23, 2018 acute kidney failure also called acute renal failure or acute kidney injury develops rapidly, usually in less than a few days.
Drug induced renal toxicity is more common in infants and young children in certain. If you have renal disease or kidney failure, talk with your doctor about. Vaccines are especially critical for people with health conditions such as renal disease. Drug induced impairment of renal function george sunny pazhayattil, anushree c shirali section of nephrology, yale university school of medicine, new haven, ct, usa abstract. Druginduced kidney disease pathology and current concepts. Renal injury has been reported in association with several herbs. Pathophysiology of acute renal failure according to kosinski 2009, acute renal failure is a sudden decline in both glomerular and tubular function, resulting in the failure of the kidneys to excrete nitrogen and waste products with a corresponding failure to maintain fluid, electrolyte and acidbase balance p. Drug induced kidney disease alwin hl loh and arthur h cohen drug induced kidney disease pathology and current concepts alwin hl loh,1mbchbhons, frcpath, arthur h cohen,2,3md introduction departing from the usual account of drug induced renal disease according to the specific type of drug, we divide. If your kidneys fail, you need treatment to replace the work they normally do.
Enalapril induced reversible acute renal failure detected by 99mtcdmsa renal scan in a patient with bilateral renal artery stenosis. These drugs need to be identified and avoided to prevent kidney injury. The incidence of drug induced nephrotoxicity is 1426% in adults and 16% in paediatric cases 1. Not graded contrast induced acute kidney injury is defined when one of the following criteria is met serum creatinine rises by. Physiopathologic effects include hemodynamic alterations, failure in the synthesis of glomerular matrix, degradation and oxidative stress and induced renal atherogenesis.
The predominant findings were marked tubular atrophy, interstitial fibrosis, interstitial inflammation, and mildtomoderate vascular disease. Druginduced renal disease is common and responsible for a variety of pathological effects on the kidney, many of which are potentially recoverable. Ace induced renal toxicity hyperkalemia hemodynamicrelated renal failure etiologic factors bilateral renal artery stenosis. Malarial nephropathy is kidney failure attributed to malarial infection. Druginduced kidney disease free download as powerpoint presentation. Acute kidney failure is most common in people who are already hospitalized, particularly in critically ill people who need intensive care. Drug induced kidney disease free download as powerpoint presentation. Acute renal failure induced by topical ketoprofen the bmj. Interstitial nephritis results from inflammation of the renal interstitium and tubules and can be caused by infections, immunemediated diseases such as sarcoidosis and lymphomas, and drugs. This lesson is about medication induced renal failure, its symptoms, and the treatment.
Druginduced renal toxicity is more common in infants and young children in. Intravenous iodinated contrast media are commonly used with ct to evaluate disease and to determine treatment response. The treatment options are dialysis or a kidney transplant. Diagnosis, management and prevention of druginduced liver injury. Clinical evidence of ag induced acute tubular necrosis is seen within 5 to 10 days of initiation of ag treatment. Recognizing the process as druginduced renal failure and stopping the drug is essential. Induction, prevention and mechanisms of contrast media. This new edition features brandnew guidance on pediatric dosing, making it the most complete resource of its kind. Succinylcholineinduced hyperkalemia in patients with.
Among various complications due to infection, renal related disorders are often the most lifethreatening. Usually zoledronate induced renal damage is reversible. Management of drug induced liver injury is symptomatic, with early referral to a. A reversible ischemic model of acute renal failure robert e. Withdrawal of the drug led to normalization of renal function within 31 days without further specific therapy. It has a high index of mortality and its mechanisms remain unknown. For some people with complete kidney failure a kidney transplant may be an option. Case report enalapril induced reversible acute renal failure. Pemetrexed induced acute kidney failure following irreversible renal damage. However, all agents also carry adverse drug effect profiles.
More days on renal replacement therapy 18% versus 9% were also required by the group receiving hes when compared to ringers lactate. Acute kidney failure singapore pdf ppt case reports. You have free access to this content prescriber volume 17, issue 3, article first published online. Renal disease induced by drugs was studied by percutaneous biopsy in 40 patients. Further, kidney damage induced by pathological events can be induced by extrinsic events such as hypertension, obesity, sepsis, liver failure, and diabetes.
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. Drug induced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. While most of these are clinically insignificant, some drugs. Drug induced nephrotoxicity tends to occur more frequently in patients with intravascular volume depletion, diabetes, congestive heart failure, chronic kidney disease, and sepsis. The condition is characterized by progressive interstitial nephritis, with a proportion of. An old question revisited sushma thapa, md, and sorin j. In discussing drug induced 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. Sep 01, 2015 drug induced renal disorders are more common in certain patients and in specific clinical situations. Drug induced kidney disease can occur due to patient related factors and in specific disease table 1. Chronic kidney disease epidemiology collaboration cohort changes in egfr and final egfr corresponding to.
Improving global outcomes kdigo definition of contrast induced acute kidney injury ciaki should be adopted. Drug induced acute renal dysfunction karen shalansky, pharm. Zoledronic acidinduced acute renal failure in multiple. State the drug induced renal structuralfunctional alterations observed, and provide examples of each. Druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Several drugs and other compounds can induce acute andor chronic nephrotoxicity. Hasbargen, md 0 isolated renal hypouricemia from defective uric acid reabsorption andor secretion is a welldescribed entity, with a prevalence of 0.
Acetaminophen induced renal failure becomes evident after hepatotoxicity in most cases, but can be differentiated from the hepatorenal syndrome, which may complicate fulminant hepatic failure. 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. Renal dysfunction and renal disease due to drugs are common and can lead to renal failure, both acute and chronic. Acute renal failure arf is defined as a rapid loss of renal function due to damage to the kidneys. 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 inhibitors celecoxib and. 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. Due to dialysis induced losses, watersoluble vitamins should be supplied. Although patients have benefited from their use, iodinated contrast media historically have been denied or delayed in patients with reduced kidney function due to the perceived risks of contrast induced acute kidney injury ci. Kdigo clinical practice guideline for acute kidney injury iv tables and figures 1 notice 2 work group membership 3 kdigo board members. Succinylcholine induced hyperkalemia in patients with renal failure.
The role of nacetylcysteine therapy in the setting of acetaminophen induced renal failure is unclear. The frequency of inhospital deterioration of renal function is about 25% 1, 2. Drug dosing adjustments in patients with chronic kidney. Drug dosing adjustments in patients with chronic kidney disease. This is particularly due to the renal uptake and elimination of bisphosphonates 15.
Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain stereotyped renal responses. A 62 year old turkish woman with chronic renal failure from polycystic kidney disease had. Ag induced acute renal failure is generally nonoliguric, and may be associated with decreasedurineconcentratingabilityand urinary magnesium wasting. Hepatic failure is a particular risk factor for drug induced renal impairment because cirrhotic patients tend to have.
Longterm cocaine use can lead to chronic renal failure. However, this is an oversimplification, since many cases have a mixture of pre, post and renal components. Drug prescribing in renal failure r2 digital library. This results in electrolyte and acidbase abnormalities and retention of nitrogenous waste products, such as urea and creatinine. Munar, pharmd, bcps, and harleen singh, pharmd oregon state university college of pharmacy, portland, oregon. Acute renal failure arf affects 57% of all hospitalized patients and continues to be associated with poor outcomes 410. A relatively new group of drugs with this potential is the cyclooxygenase2 selective inhibitors. Anemia in adenineinduced chronic renal failure and the. Full text druginduced impairment of renal function ijnrd. Gentamicininduced acute renal failure model creative. Drug induced kidney disease dikd is a significant contributor of acute kidney injury aki and chronic kidney disease ckd. Medication induced renal failure is a commonly seen problem, especially in the. Drugs most often implicated in the development of interstitial nephritis.
Pdf mechanisms of bee venominduced acute renal failure. Acute kidney failure can be fatal and requires intensive treatment. Kdigo clinical practice guideline for acute kidney injury. Acute kidney injury aki, formerly referred to as acute renal failure arf, is defined as an acute reduction in kidney function that results in a decline in glomerular filtration rate gfr, leading to retention of urea and other nitrogenous waste products and loss of fluid, electrolyte, and acidbase regulation. Nemmar3 1department of pharmacology and clinical pharmacy, college of medicine and health sciences, sultan qaboos university, al khod, oman, 2department of medicine and 3department. Permanent renal failure induced by pentastarch clinical. Kidney transplant unfortunately dialysis cannot make the kidneys work again. Pemetrexed induced acute kidney injury in patients with nonsmall cell lung cancer. When kidneys have failed, dialysis must go on for the rest of the persons life, unless the person can get a new kidney. List the drugs most commonly implicated in acute tubular necrosis.
Drug induced 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. Drug induced nephrotoxicity is caused by nephrotoxic drugs that cause kidney damage. Herbal medicines and chronic kidney disease jha 2010. Druginduced renal disorders journal of renal injury. Drug induced kidney disease dikd clinical pharmacy by. Rhabdomyolysis is the main cause responsible for renal injury. Druginduced acute renal dysfunction karen shalansky, pharm.
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. The mechanism of bisphosphonate induced atn has been described by markowitz et al. The main types of renal injury predominantly involve the tubules and interstitium, leading to acute tubular injury and necrosis, or interstitial nephritis with inflammatory tubular injury. Hpv vaccine to protect against cancers and genital warts caused by human papillomavirus if you are an adult. Particularly, creative biolabs provides an acute renal failure arf model induced by gentamicin, which is among the most common causes of aki, to evaluate in vivo nephroprotective activity of potential compounds. Patient specific disease specific age older than 60 years diabetes genetic variation in cyp3a4, mdr1, ace, tgf. Pdf mechanisms of acute renal failure researchgate.
Acute kidney failure occurs when your kidneys suddenly become unable to filter waste products from your blood. Cite the risk factors for aminoglycoside and radiocontrast induced nephrotoxicity. Zoster vaccine to protect against shingles if you are 60 years and older. This study describes the development of an experimental model of reversible acute renal failure following infusion of contrast media radiographic dye. Pharmaceutical agents provide diagnostic and therapeutic utility that are central to patient care. Some patientrelated risk factors for druginduced nephrotoxicity are age older than 60 years, underlying renal insuf ficiency e. Hemodynamic renal failure may result from drugs that reduce renal prostaglandins and hence renal blood flow and glomerular filtration rate. Compare and contrast acute tubular necrosis and acute allergic interstitial nephritis. The chronic renal failure was likely degenerative due to his age, and the acute failure due to his new medications. Diagnosis of drug induced 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 drug related signature.
Druginduced nephrotoxicity tends to occur more frequently in patients with intravascular volume depletion, diabetes, congestive heart failure, chronic kidney disease, and sepsis. Medications cause renal failure through a variety of mechanisms. Despite the differences in definitions, there are several commonalities between nephrotoxicity and renal pathology. Drug induced kidney diseases authorstream presentation. In a case of undiagnosed renal disease a possibility of drug induced renal failure should be kept as the prompt removal of the drug and supportive management can reverse the renal dysfunction to a. Conventionally, the causes of arf are classified by renal anatomy into pre renal, renal and post renal. Cocaine use can cause renal artery thrombosis clotting, severe hypertension and interstitial nephritis. Larrea tridentate chaparral chaparral induced nephrotoxicity is reported in a single case involving a 56yrold woman with a 3mo history of chaparral ingestion 18 mo before diagnosis 34. The patient presented with an elevated scr and was found to have bilateral renal cystic disease and cystic renal cell. Hepatic failure is a particular risk factor for druginduced renal impairment because cirrhotic patients tend to have reduced muscle mass and hypoalbuminemia, which, as discussed earlier, increases the chance of inadvertent drug overdosing. No matter which treatment you choose, youll need to make some changes in your life, including how you eat and plan your activities. Druginduced renal disease diagnostic histopathology.
Drug induced kidney disorder disease dkid is an origin of kidney disease followed by acute renal failure. This syndrome is common in the intensive care unit icu, with a reported incidence of 125% 11. Features and management of druginduced renal failure. The cost of one survivor leaving icu with renal failure is 70 times that of a patient without renal impairment. When your kidneys lose their filtering ability, dangerous levels of wastes may accumulate, and your bloods chemical makeup may get out of balance due to loss of electrolytes. Dec 12, 2014 overview of drug induced renal impairment. Brull, md department of anesthesiology, university of arkansas for medical sciences, little rock, arkansas t he administration of succinylcholine sch in humans results in a mild and transient hyperkalemia. Including malaria induced renal lesions, infection may lead to both tubulointerstitial damage and glomerulonephritis. Jan 19, 2016 injury patterns subtle injury or overt renal failure some drugs perturb renal perfusion and induce loss of filtration capacity others directly injure vascular, tubular, glomerular and interstitial cells specific loss of renal function leads to clinical findings microangiopathy acute tubular necrosis acute.
Induction, prevention and mechanisms of contrast media induced acute renal failure. Pseudo renal failure bun due to protein catabolism steroids, tetracyclines scr due to competitive inhibition of creatinine secretion trimethoprim, cimetidine, triamterene trimethoprim 1535% rise scr fully expressed after 3 days more sig in pts with preexisting renal dysfunction can occur with normal doses completely reversible when drug is discontinued. Treatment options for chronic kidney disease 4 is dialysis forever. Ppt druginduced kidney disease powerpoint presentation. Acute renal failure and other complications induced by. Mechanisms of bee venom induced acute renal failure.
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