The potential of medications to cause kidney injury is well known. Tenofovir, used in combination with other antiretroviral agents, is an effective therapy for hiv infection. Drug induced kidney disease free download as powerpoint presentation. Renal medicine and clinical pharmacy rhiannon braund springer. Each stage is defined by the patients egfr or estimated gfr which is calculated using the mdrd modification of diet in renal disease equation. Renal disease was attributable to biopsy proven renal sarcoid in 10 out of the 18 patients and was attributed to other causes in 8 patients. Disorders, ophthalmic disorders, psychiatric disorders, renal disorders, respiratory disorders, and urologic disorders. It has high morbidity and mortality incidence in 4070% of renal injuries and accounts for 66% cases of renal failure in elderly population. Druginduced nephrotoxicity tends to occur more frequently in patients with intravascular volume depletion, diabetes, congestive heart failure, chronic kidney disease, and sepsis. Other types of systemic and kidney disease may also increase the nephrotoxic effects of drugs. Ppt drug induced nephrotoxicity powerpoint presentation. Multitarget tyrosine kinases such as regorafenib are increasingly used in metastatic.
In a case of undiagnosed renal disease a possibility of drug induced renal failure should. Patients are exposed to numerous prescribed and overthecounter medications. 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 large extent. Pdf renal function recovery in endstage renal disease. Pdf use of belatacept as alternative immunosuppression in. A prospective study of renal disease in patients with early. Conclusions venkat, outcome of plasma exchange therapy in thrombotic microangiopathy ater renal transplantation, american journal to our knowledge, this is the largest series of renal transplant of transplantation, vol. Pdf sarcoidosis and kidney disease anirban ganguli. From bedside to bench druginduced tubulointerstitial disease. Nonsteroidal considered that the local synthesis of. Importantly, underlying acute and ckd further increase risk for drug related. Ppt druginduced kidney disease powerpoint presentation.
The gbm usually has a normal texture and thickness. Druginduced kidney disease is the property of its rightful owner. Pharmacology behind common drug nephrotoxicities american. Mr antagonists mras have demonstrated therapeutic actions in chronic kidney disease ckd, diabetic nephropathy dn, renal fibrosis, and drug. Drug induced kidney diseases nonsteroidal anti inflammatory. The associations between each diagnosis of kidney disease in childhood congenital anomalies of the kidney and urinary tract, pyelonephritis, and glomerular disease and the risk of esrd in. Similarly, aki from oral acyclovir is described in case reports, but the risk in routine practice is unknown. Interfere with the mitochondrial function by increasing the oxidative stress and forming free radicals. Polycystic kidney disease optimal use of aceiarb nejm 2002. Jan 01, 2020 drug induced nephrotoxicity is a frequent adverse event that can lead to acute or chronic kidney disease and increase the healthcare expenditure. Drug induced kidney disease the kidney maintains the vital functions of clearing excess body fluid and removing metabolic and exogenous toxins from the blood the kidney is particularly. Druginduced nephrotoxicity american academy of family. Druginduced renal disease is common and responsible for a variety of pathological effects on the kidney, many of which are potentially recoverable. Drug induced kidney disease occurs primarily in patients with underlying risk factors.
Drug induced conditions associated with allergic and pseudoallergic reactions, hematologic disorders, liver disease, pulmonary disorders, and kidney disease. Sep 15, 2008 patients at highest risk of drug induced nephrotoxicity are those with one or more of the following. Drug induced interstitial nephritis is being recognized with increasing frequency. We convened a panel of international, adult and pediatric, nephrologists and pharmacists to develop standardized phenotypes for drug induced kidney disease as part of the phenotype standardization project initiated by the. Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes disorders. Few largescale studies of the subject have been reported.
Although granulomas may also form in drug induced interstitial nephritis it is less well formed than in sarcoidosis. Importantly, underlying acute and ckd further increase risk for drugrelated. We observed that qct restored the levels of plasma creatinine and urea which is an indication of renal protection. Association of proton pump inhibitors and concomitant.
Druginduced fanconis syndrome american journal of kidney. The renal drug handbook 5th edition medicina interna. Statistical analysis the data obtained were analysed by. Progressive renal disease is associated from the earliest stages with increased qt interval and dispersal and with an increased risk of cardiovascular death, specifically sudden death. Pdf use of belatacept as alternative immunosuppression. Druginduced renal disease current diagnostic pathology. Drug induced calculi represent 12% of all renal calculi. Ethanolic extract of trigonella foenum graecum attenuates. 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 renal drug handbook third edition edited by caroline ashley and aileen currie uk renal pharmacy group foreword by dr aine burns radcliffe publishing. Renal cell death can be mediated by drug transporters that determine the selectivity for the tubular cell, mitochondrial damage, and drug. Drug induced kidney disease is a frequent cause of renal dysfunction. Drugs known to be nephrotoxic include several cancer therapeutics, drugs of abuse. R enal function recovery rfr has been reported in 1 % to 4% of patients on maintenance renal replacement therapy rr t for presumed endstage renal disease esrd.
They also presented rare causes of druginduced hyponatremia derived from occasionally reported cases. Renal pathophysiology the essentials 5th edition pdf free. The comprehension of the effect of csa in renal epithelial cells gives us more insight in understanding drug induced renal tubulointerstitial disease. Results based on clinical and pathological diagnoses, 328 cases 176 males and 152 females of renal biopsyproven. One, two, or all three of the factor categories can act to promote various forms of renal injury. Phenotype standardization for druginduced kidney disease. The drugs reported to produce calculi formation may be divided into two groups. Although it is impossible to present all the drugs causing renal disease, a few prototype drugs are mentioned. Any stimuli that induce loss of these cells can induce kidney damage and renal failure. They are broadly categorized as patientspecific, kidney related, and drug related factors. However, it may be more useful from a clinical point of view to classify drug induced renal toxicity into four major renal syndromes. Radcliffe publishing ltd 18 marcham road abingdon oxon ox14 1aa united kingdom.
The renal drug handbook third edition edited by caroline ashley and aileen currie uk renal pharmacy group foreword by dr aine burns radcliffe publishing oxford new york. Druginduced diseases are adverse effects of drugs on different organs or parts of the body. The kidney maintains the vital functions of clearing excess body fluid and removing metabolic and exogenous toxins from the blood the kidney is particularly vulnerable to drugs and other agents that cause renal damage the heart pumps approximately 25% of cardiac output into the kidneys any drug in the blood will. However, many drugs were not included in the investigators. Renal vulnerability to drug toxicity american society of. Cisplatin intoxication resulted in structural and functional renal and hepatic imp. We propose four phenotypes of drug induced kidney disease based on clinical presentation. The nephrotoxic drugs were selected from the drugs available in japan, according to the drug formulary described in the clinical practice guideline for drug induced kidney injury in japan 2016 published by the japanese society of nephrology online supplemental table 3. A contemporary overview and prevention strategies king faisal specialist hospital and research center kfshrc is accredited by the accreditation council for pharmacy education as a provider of continuing pharmacy education. Drug induced kidney disease alwin hl loh and arthur h cohen cellular, tip and collapsing.
A number of factors enhance the vulnerability of the kidney to the nephrotoxic effects of drugs and toxins. There is a genuine need for a book to describe current laboratory methods and integrate the results obtained with historical, physical and. Renal disease was attributable to biopsy proven renal sarcoid in 10 out of the 18 patients and was attributed to other. Druginduced hospitalacquired acute kidney injury in china. Markowitz and others were the first to report the association between pamidronate and collapsing glomerulopathy. Drug induced renal damage was defined as renal damage that developed after the drug was started and which disappeared when the drug was stopped. However, establishing causality in drug induced kidney disease is. We aimed to study the protective effect of fenugreek fg on cp induced renal and hepatic injuries in rats. Although nephrotoxicity is most commonly associated with injury in the tubulointerstitial compartment as either acute tubular necrosis or acute interstitial nephritis, a growing body of literature has also highlighted the potential for drug induced glomerular lesions. Creatinine 159 to 194 in 2 weeks accept 2030% increase in serum creatinine within 12 months of initiation in fact, this could be an indication that the drugs are exerting their desired actions to help preserve renal function. Pdf protective effect of quercetin on melphalan induced. Changes of oral mucous membrane in some systemic diseases gastrointestinal, cardiovascular, endocrine and nervous systems lecturer.
Laboratory diagnosis of kidney diseases jama jama network. Pharmacologic agents responsible for inducing this entity include antibiotics, diuretics, and nonsteroidal antiinflammatory drugs. Subjects and methods we analyzed the data of 26,535 cases that were registered in the jrbr from 2007 to 2015. By some estimates, up to 1in3 cases of acute kidney injury aki can be attributed to the effect of prescribed drugs and endogenousexogenous toxins. Kidneybased in vitro models for druginduced toxicity testing. Druginduced renal disorders journal of renal injury.
Additional chapters provide detailed information on the methods and pharmacokinetics of renal dialysis, and the epidemiology and management of drug induced nephrotoxicity. Drug induced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. Drug induced renal impairment is generally reversible, provided the. The challenge is how to accurately estimate a patients kidney function in both acute and chronic kidney disease and determine the influence of renal replacement therapies on drug disposition. We used the atc index codes or the specific names to identify the. Diagnosis is made by clinical suspicion, distinctive clinical patterns and usually improvement in renal function on drug withdrawal. 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.
Drug dosage adjustment for patients with acute or chronic kidney disease is an accepted standard of practice. Drug induced nephrotoxicity tends to occur more frequently in patients with. Druginduced renal disorders journal of renal injury prevention. In recent years, the classification for chronic kidney disease ckd has changed, now being described as ckd stages 15. Druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day. The initial diagnosis of drug induced kidney disease dikd typically involves. Scribd is the worlds largest social reading and publishing site. A high index of suspicion is necessary to detect druginduced renal disease particularly with increasing availability of overthecounter drugs. Melatonin ameliorates the drug induced nephrotoxicity.
The alterations were correlative and interactive to each other. This includes antitumor necrotic factor and other antibody agents used in cancer treatment. A combination of factors including the innate nephrotoxicity of drugs, underlying patient characteristics that increase their risk for kidney injury, and the metabolism and pathway of excretion by the kidneys of the various. Nephroand hepatotoxicities are important complications in cancer patients undergoing cisplatin cp therapy. Druginduced kidney disease pathology and current concepts. Other wellwritten papers describe microdissection of the nephron, urinary calculi, drug induced nephropathy, immunopathogenesis of renal disease, and the association between renal and liver disease. Full text druginduced impairment of renal function ijnrd. Early human studies and experimental evidence suggested that tenofovir itself was not associated with. Druginduced kidney disease kidney kidney disease free. From bedside to bench druginduced tubulointerstitial. Role of mineralocorticoid receptor antagonists in kidney. Drug induced kidney diseases free download as powerpoint presentation.
One point to note is that the egfr is normalised to a standard body. Piroxicaminduced renal disease jama internal medicine jama. Patients at highest risk of drug induced nephrotoxicity are those with one or more of the following. Renal pathophysiology the essentials 5th edition pdf free download renal pathophysiology can be a difficult subject even for the most advanced medical students. This also confirms the protective role of qct against drug induced renal toxicity as previously reported 50, 51. Unfortunately, drugs remain a relatively common cause of acute and chronic kidney injury. We recently examined five patients with glomerular disease and drug induced interstitial nephritis. Role of mineralocorticoid receptor antagonists in kidney diseases. As more investigators have taken advantage of relatively new methods to isolate pure nonparenchymal cells, there have been rapid gains in information on the contribution of kupffer cells, sinusoidal endothelial cells, and stellate cells to a variety of liver diseases, including drug and toxin induced liver injury chapter 10. Drug induced lupus glomerular diseases have historically been associated with hydralazine, but new drugs that modify the growth, metabolism, and immunity of cells are increasingly found to cause glomerular disease.
Druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain. 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. These studies highlighted that alleviation of druginduced renal toxicity is a. Although it is the primary therapeutic option at present, transplanted patients have to deal with the numerous side effects of infusion of thirdparty mesenchymal stem cells msc after kidney and liver transplantation. Anticancer druginduced acute kidney injury sciencedirect. Pdf drug induced kidney disease constitutes an important cause of acute renal failure. Reduction of renal function by newer nonsteroidal antiinflammatory drugs.
A free powerpoint ppt presentation displayed as a flash slide show on id. The first one includes poorly soluble drugs with high urine excretion that favours crystallisation in the urine. The essentials provides an easytoread, casebased approach to learning the mechanisms of renal disease. Organ transplantation is the only definite treatment of many critical diseases of the liver, kidney, heart, pancreas and lung. Acquired renal tubular defects resulting in fs also have been described in. Druginduced nephropathy is of great general interest given the evergrowing number of medications, including herbal, that patients are taking. Although large clinical studies and postmarketing data support a benign renal profile for tenofovir, numerous cases of kidney injury raise concern for nephrotoxic potential. Feb 01, 2007 renal dysfunction and renal disease due to drugs are common and can lead to renal failure, both acute and chronic. Downloaded from the american family physician web site at. Drug induced acute kidney injury daki is one of the important types of aki. The purpose of this report is to clarify drug induced kidney disease dikd of renal biopsied cases in japan.
379 1393 1475 297 1203 16 566 128 101 790 1552 87 1045 161 1506 1385 1546 879 588 1028 134 1167