Drug induced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Prevention, detection, and management begin by defining druginduced disease did as, an unintended effect of a drug that may result in morbidity or mortality with symptoms sufficient to prompt a patient to seek medial attention andor require hospitalization. Cite the risk factors for aminoglycoside and radiocontrast induced nephrotoxicity. Pharmaceutical agents provide diagnostic and therapeutic utility that are central to patient care. However, all agents also carry adverse drug effect profiles. Chronic kidney disease is associated with mitochondrial dysfunction that leads to an imbalance between reactive oxygen species and the natural antioxidants that normally.
The incidence of arf, although relatively common, is difficult to define, and the incidence of druginduced renal failure dirf is even more difficult to ascertain. Renal disease and dialysis alters the pharmacokinetics and. An overview of drug induced acute kidney injury neesh pannu, md, sm, frcp. Acute kidney injury acute renal failure explained clearly bun creatinine ratio duration. 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. Mar 21, 2007 the incidence of arf, although relatively common, is difficult to define, and the incidence of drug induced renal failure dirf is even more difficult to ascertain. Drug induced kidney diseases free download as powerpoint presentation. Chronic kidney disease ckd american society of nephrology. The exact frequency of nephrotoxicity induced by antiviral drugs is difficult to determine. 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. Overview of druginduced renal impairment 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.
The clinical manifestations of drug induced renal disease may include all the manifestations attributed to natural or spontaneous renal diseases such as acute renal failure, chronic renal failure, acute nephritic syndrome, nephrotic syndrome, renal colic, haematuria, selective tubular defects, obstructive nephropathy, etc. Druginduced kidney injury is a major side effect in clinical practice, frequently leading to acute renal failure arf. 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. It is therefore vital in any patient with renal disease whatever the. Identify the components of the history required to rule inout a drug causation. Pepper professor of public health and preventive medicine professor of biostatistics and epidemiology, medicine, and pharmacology vice dean for institutional affairs university of. Chronic drug induced renal damage o cyclosporine o aristolochic acid nephropathy o warfarin o takaout. Mechanisms of druginduced acute and chronic renal damage. Druginduced renal disease diagnostic histopathology. Druginduced impairment of renal function george sunny pazhayattil, anushree c shirali section of nephrology, yale university school of medicine, new haven, ct, usa abstract. Some of the risk factors of dids are multiple chronic diseases, multiple physicians, hospitalization, medical or surgical procedures, long duration of medicine use, advancing age, female sex and a particular class of drugs 6,7,8. State the drug induced renal structuralfunctional alterations observed, and provide examples of each. Perazella abstract drugs and toxins frequently are associated with the development of various types of acute kidney disease and ckd. This article provides a summary of the most common mechanisms of drug induced nephrotoxicity and prevention strategies.
Concentration of the drug in the urine and urinary. Drug induced kidney diseases nonsteroidal anti inflammatory. Patient specific disease specific age older than 60 years diabetes genetic variation in cyp3a4, mdr1, ace, tgf. Back to drug induced diseases, 3rd edition protect your patients. Renal phospholipidosis possibly induced by ranolazine. The true incidence of druginduced acute and chronic interstitial. 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. Its exact incidence is diffi cult to document but about 40,000 to 45,000 people may experience a druginduced liver injury each year.
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. Electronic surveillance presents a powerful tool to identify susceptible. Medcram medical lectures explained clearly 543,516 views 15. Pdf druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice find. Drug induced kidney disease 1 drug induced kidney disease 2 introduction. However, it may be more useful from a clinical point of view to classify drug induced renal toxicity into four major renal syndromes. Jan 19, 2016 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. The drug induced renal injury consortium direct the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The drug induced renal injury consortium full text view. Compare and contrast acute tubular necrosis and acute allergic interstitial nephritis. Druginduced nephrotoxicity is a common problem in clinical medicine and the incidence of drugrelated acute kidney injury aki may be as high. Identify an approach to incorporating did wi the differential.
While most of these are clinically insignificant, some drugs. Nephrology and renal diseases is an open access journal and we do not charge the end user when accessing a manuscript or any article. Drug induced nephrotoxicity is a common problem in clinical medicine and the incidence of drug related acute kidney injury aki may be as high as 60 percent 14. Although medications are a widely known cause of tubulointerstitial damage, drug related glomerular. Listing a study does not mean it has been evaluated by the u. Chair and professor, department of biostatistics and epidemiology director, center for clinical epidemiology and biostatistics george s.
Kidneybased in vitro models for druginduced toxicity testing. Management of druginduced liver injury is symptomatic, with early referral to a liver transplant unit at the first hint of liver. Ppt druginduced kidney disease powerpoint presentation. Recent advances in the treatment of renal diseases with. Drug induced kidney injury is a major side effect in clinical practice, frequently leading to acute renal failure arf. While overall not well defined in children, the incidence of aki in the paediatric intensive care units is reported to range from 8% to 30% and is thought to occur in. It accounts for more than 2% to 15% of cases of arf in patients admitted to the hospital or in the intensive care unit, respectively. Renal insufficiency and intravascular volume depletion increase the risk of crystal nephropathy. Identify risk factors for high probability did causation. Diagnosis, management and prevention of druginduced liver. Pdf druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying. 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. Antiviral druginduced nephrotoxicity american journal of. It gives american society of healthsystem pharmacists 7272 wisconsin avenue bethesda, md 20814 this vital subject the comprehensive coverage that it deserves.
Renal vulnerability to drug toxicity nephrology selfassessment program vol 9, no 4, july 2010 clin j am soc nephrol 4. Management of drug induced liver injury is symptomatic, with early referral to a liver transplant unit at the first hint of liver. Nadim, md a cute kidney injury aki is a relatively common condition in the intensive care unit and occurs in 20% to 30% of critically ill patients, with approximately 6% eventually requiring renal replacement therapy 1. Prevention, detection, and management is a well organised, easy to use reference source that fills a sizeable gap in the available literature. Identify the laboratory tests required to rule inout as druginduced causation. Chronic kidney disease ckd, also known as chronic renal disease is a term used to describe kidney. Cite the risk factors for aminoglycoside and radiocontrastinduced nephrotoxicity. Identify the laboratory tests required to rule inout as drug induced causation. 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.
The initial diagnosis of drug induced kidney disease dikd typically involves detection of elevated serum creatinine s cr and blood urea nitrogen, for which there is a temporal relationship between the toxicity and use of a potentially nephrotoxic drug drug induced kidney disease is best prevented by avoiding the use of potentially nephrotoxic agents for patients at. The condition can be costly and may require multiple interventions, including hospitalization. Diagnosis, management and prevention of druginduced liver injury. They proceed to explore these effects via the 12 major sections of the text. This allows the scientific community to view, download, distribution of an article in any medium, provided that the original work is properly cited, under the term of creative commons attribution license. Drug induced kidney injury is a frequent adverse event which contributes to morbidity and increased healthcare utilization. The clinical manifestations of drug induced renal disease may include all the manifestations attributed to natural or spontaneous renal diseases such as acute renal failure, chronic renal failure, acute nephritic syndrome, renal colic, haematuria, selective tubular defects, obstructive nephropathy, etc. Some drugs induce renal injury in the context of a systemic syndrome. The drugs reported to produce calculi formation may be divided into two groups. Full text druginduced impairment of renal function ijnrd. Among poorly soluble molecules, triamterene was the leading cause of drugcontaining urinary calculi in the 1970s, and it is still currently.
Kidney is one of the major organ of drug elimination from the human body. List the drugs most commonly implicated in acute tubular necrosis. The 6rs of drug induced nephrotoxicity bmc nephrology. Drug induced kidney disease can occur due to patient related factors and in specific disease table 1. Despite best efforts to assure that all drugs are safe and effective, millions of patients each year develop drug induced diseases.
Drug induced kidney disease is associated with increases in mortality, length of stay, and healthcare costresources. Druginduced kidney disease free download as powerpoint presentation. Antiviral druginduced nephrotoxicity american journal. Following crush injury, drug overdose, status epilepticus. Druginduced calculi represent 12% of all renal calculi. Druginduced acute kidney injury in children faught 2015. Since the first edition of this book was published in 2005, numerous drugs have been withdrawn from the market in the united states as a result of morbidity andor mortality associated with drug induced diseases. Patients at highest risk of drug induced nephrotoxicity are those with one or more of the following. 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 kidney disease pathology and current concepts. Since it is virtually impossible to distinguish an iatrogenic druginduced pl from fabrys disease on ultrastructural analysis of kidney tissue, the clinician has to use the patients family history, extrarenal symptoms, and biochemical features, such as a reduced. Druginduced kidney disease 1 druginduced kidney disease 2 introduction. Our current knowledge of drug induced kidney disease is limited due to varying definitions of kidney injury, incomplete assessment of concurrent risk factors and lack of long term outcome reporting.
Patients at highest risk of druginduced nephrotoxicity are those with one or more of the following. 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. The kidney is particularly vulnerable to drugs and other agents that cause renal damage. Druginduced kidney disease kidney kidney disease free. Renal biopsy in patients with unexplained renal impairment and normal kidney size. Druginduced diseases did also called as iatrogenic diseases, are well known but least studied entity. Acute kidney injury aki may occur 3 to 16 months after cpi exposure, which makes extended renal function monitoring critical for detection and treatment. Druginduced acute kidney injury in children faught. Pepper professor of public health and preventive medicine professor of biostatistics and epidemiology, medicine, and pharmacology vice dean for institutional affairs university of pennsylvania. Acute kidney injury aki can be described as the sudden decrease in renal function over a variable period of time hours to days and can be caused by numerous aetiologies. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain stereotyped renal responses. A definitive guide to drug induced disease now in its third edition, this comprehensive guide provides a detailed overview of diseases that result from drug therapy, arming healthcare professionals with critical knowledge to protect the health and welfare of their patients.
Druginduced acute renal dysfunction karen shalansky, pharm. 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. Renal dysfunction and renal disease due to drugs are common and can lead to renal failure, both acute and chronic. Renal, or kidney, failure may occur as a result of taking various kinds of medication, including both prescription and overthecounter drugs. State the druginduced renal structuralfunctional alterations observed, and provide examples of each. The first one includes poorly soluble drugs with high urine excretion that favours crystallisation in the urine. Renal disease induced by drugs 112 have increased in geometrical progression over the last 20 years. Nephrology journal nephrology and renal diseases journal. The pulsating pressure of blood flow through an artery. Oxidative stress is known to play an important role in the development of renal diseases such as glomerulonephritis, drug induced nephrotoxicity and chronic kidney disease. Why is the kidney at risk for drug induced diseases. The kidney maintains the vital functions of clearing excess body fluid and removing metabolic and exogenous toxins from the blood.