Doserelated nephrotoxicity subsequent to administration of certain chloroethylnitrosourea compounds carmustine, semustine and streptozocin is commonly heralded by increased serum creatinine levels, uraemia and proteinuria. Certain drugs can cause alteration in intraglomerular hemodynamics. Druginduced acute renal dysfunction karen shalansky, pharm. Renal hypertension, also called renovascular hypertension, is elevated blood pressure caused by kidney disease. Renal vulnerability to drug toxicity american society of. 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. Renal disease induced by drugs was studied by percutaneous biopsy in 40 patients. The purpose of this report is to clarify drug induced kidney disease dikd of renal biopsied cases in japan. Drug induced kidney diseases authorstream presentation. Druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Longterm cocaine use can lead to chronic renal failure.
Phenotype standardization for drug induced kidney disease. Drug induced kidney disease alwin 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 drug induced renal disease according to the specific type of drug, we divide. Drug induced renal disease is common and responsible for a variety of pathological effects on the kidney, many of which are potentially recoverable. Druginduced renal disease diagnostic histopathology.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. Drug induced 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. 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. Distinguish among the different types of acute kidney injury aki and identify drug induced causes. 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. Druginduced renal disorders journal of renal injury prevention. Patients at highest risk of drug induced nephrotoxicity are those with one or more of the following. Druginduced nephrotoxicity is caused by nephrotoxic drugs or toxins which damage kidneys and can lead to nephritis or renal toxicity.
Druginduced renal disease, like other iatrogenic disorders, bedevils the patient and humbles the physician. Patients are exposed to numerous prescribed and overthecounter medications. Anticancer druginduced kidney disorders springerlink. They are broadly categorized as patientspecific, kidney related, and drug related factors. Nsaids, angiotensin converting enzyme inhibitors acei and contrast agents are the major culprit drugs contributory to kidney damage. Scribd is the worlds largest social reading and publishing site. Thirtyone different drugs produced the following clinical entities. 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. Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes. C 7, 10, 32, 48 druginduced renal impairment is generally reversible, provided the nephrotoxicity is recognized early and the offending medication is discontinued. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain. A drug induced disease is the unintended effect of a drug, which results in mortality or morbidity with symptoms sufficient to prompt a patient to seek medical attention andor require hospitalization.
Phenotype standardization for druginduced kidney disease. Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes disorders. Introduction the japan renal biopsy registry jrbr was started in 2007 by the committee for the standardization of renal pathological diagnosis and the committee for the kidney disease registry of the japanese society of nephrology. Drug induced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. It can usually be controlled by blood pressure drugs. Pdf druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice find. Progressive renal insufficiency associated with amiodarone.
Nonsteroidal antiinflammatory drug induced acute kidney. Perazella abstract drugs and toxins frequently are associated with the development of various types of acute kidney disease and ckd. Electronic surveillance presents a powerful tool to identify susceptible. 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 kidney disease occurs primarily in patients with underlying risk factors. Drug induced nephrotoxicity is more common in hospitalized patients, in. Although medications are a widely known cause of tubulointerstitial damage, drug related glomerular. Druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal. One, two, or all three of the factor categories can act to promote various forms of renal injury.
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. Pdf druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying. Druginduced renal disease is common and responsible for a variety of pathological effects on the kidney, many of which are potentially recoverable. However, establishing causality in drug induced kidney disease is.
The causative drug must be identified and its use must be. In summary, phospholipidosis can be induced by a number of cationic amphiphilic drugs, including amiodarone, which cause renal and corneal morphological findings mimicking fabry disease. Ppt druginduced kidney disease powerpoint presentation. Drug dosage adjustment for patients with acute or chronic kidney disease is an accepted standard of practice. 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.
Druginduced nephrotoxicity american family physician. Druginduced kidney disorder disease dkid is an origin of kidney disease followed by acute renal failure. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain stereotyped renal responses. Druginduced kidney disease free download as powerpoint presentation. An overview of drug induced acute kidney injury neesh pannu, md, sm, frcp. By some estimates, up to 1in3 cases of acute kidney injury aki can be attributed to the effect of prescribed drugs and endogenousexogenous toxins. Drug induced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Drug dosing adjustments in patients with chronic kidney. Drug induced kidney injury is a frequent adverse event which contributes to morbidity and increased healthcare utilization. Drug induced kidney disease dikd is a significant contributor of acute kidney injury aki and chronic kidney disease ckd. 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. Clinical and laboratory findings were correlated with morphology, both by light and light and electron microscopy. 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.
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. Druginduced renal toxicity is more common in infants and young children in certain. Druginduced kidney disease annals academy of medicine. A number of factors enhance the vulnerability of the kidney to the nephrotoxic effects of drugs and toxins.
Cocaine use can cause renal artery thrombosis clotting, severe hypertension and interstitial nephritis. Chronic druginduced skin disorders drug induced lupus dil. Druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations. The initial diagnosis of druginduced 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. Druginduced kidney disease pathology and current concepts. Druginduced renal disorders are more common in certain patients and in specific clinical situations. 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. A high index of suspicion is warranted if a renal biopsy is suggestive of fabry disease, because these patients and their family members may benefit from.
Druginduced kidney disease is best prevented by avoiding the use of potentially. Drug induced thrombocytopenia is the most common druginduced hematologic disorders, with some reports suggesting that as many as 5% of patients who receive heparin develop heparin induced thrombocytopenia. 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. Drug induced kidney disease is a frequent cause of renal dysfunction. Unfortunately, drugs remain a relatively common cause of acute and chronic kidney injury. C a rise in serum creatinine s cr and blood urea nitrogen bun. Recognizing the process as druginduced renal failure and stopping the drug is essential. This rare adverse effect occurs in approximately 15,000 to 30,000 individuals per year in the united states. 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. Demonstrate knowledge of protein, caloric, electrolyte, and trace element requirements in aki with and without renal. Departing from the usual account of druginduced renal disease according to the specific type of drug, we divide this discussion into 3 main areas.
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