Druginduced renal toxicity is more common in infants and young children in certain. If you need further assistance please call the national hiv and tb hcw hotline, 0800 212 506 021 406 6782 send an sms or please call me to 071 840 1572. Polypharmacy may increase the risk of hepatotoxic reactions. Drug induced renal failure is a wellrecognised phenomenon, although the incidence of drug induced renal disease remains uncertain. The risk of contrastinduced nephropathy is highest in diabetics and chronic kidney disease diabetes 9. Thus, the patient who is on diuretic therapy or has. An overview of drug induced acute kidney injury neesh pannu, md, sm, frcp. One, two, or all three of the factor categories can act to promote various forms of renal injury. For example, nonsteroidal antiinflammatory drugs are more likely to cause liver disease if. Individual druggys in a class still vary considerably 5. Drug induced kidney disease dikd is a significant contributor of acute kidney injury aki and chronic kidney disease ckd. The 6rs of drug induced nephrotoxicity bmc nephrology. Druginduced kidney disease pathology and current concepts.
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. Differentiate drug induced liver disease from other causes of liver pathology, using knowledge of liver function tests and other signs and symptoms. Therefore, the diagnosis is often difficult and, in most cases, is based on exclusion of all other possible causes. Clinical evidence of ag induced acute tubular necrosis is seen within 5 to 10 days of initiation of ag treatment. However, some reports suggest that between 5 and 20 per cent of cases of acute renal failure can be directly attributed to drugs and chemicals, although minor damage may pass undetected. Recognizing the process as druginduced renal failure and stopping the drug is essential.
They are broadly categorized as patientspecific, kidney related, and drug related factors. 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. Indeed, the kidney is an organ particularly vulnerable to drug toxicity in the body by its own functions of filtration, concentration and disposal as well as its rich vascularization 2. To analyze the clinical characteristics of patients with drug induced liver andor kidney injury. Perazella, md, facp associate professor of medicine director, renal fellowship program yale university school of medicine. Renal failure how drugs can damage the kidney learning. 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.
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. Introduction drug induced acute kidney injury aki is frequent in clinical practice 1. State the drug induced renal structuralfunctional alterations observed, and provide examples of each. List the drugs most commonly implicated in acute tubular necrosis. Drug dosage adjustment for patients with acute or chronic kidney disease is an accepted standard of practice. Feb 22, 2016 drug induced kidney diseases scientific team. Pharmacotherapeutic specialist, vgh clinical professor, ubc apr 8, 2010 outline pseudo renal failure acute renal failure. This is a letter issued to a requester that briefly describes cders thoughts on the potential value of a biomarker and encourages further evaluation. Identify the laboratory tests required to rule inout as drug induced causation. 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. 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. 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.
Renal vulnerability to drug toxicity american society of. Nephrology certification examination blueprint purpose of the exam the exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment. Clinical characteristics of 162 patients with druginduced. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain. 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. It is therefore vital in any patient with renal disease whatever the.
Chair and professor, department of biostatistics and epidemiology director, center for clinical epidemiology and biostatistics george s. 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. Hivassociated nephropathy and druginduced renal injury. Druginduced kidney disease is best prevented by avoiding the use of potentially nephrotoxic agents for patients at increased risk for toxicity. Drugs including antimicrobials, chemotherapeutic agents and nonsteroidal antiinflammatory drugs nsaids, among others, have all been implicated in drug induced renal injury in children. Druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Drug induced kidney disease can occur due to patient related factors and in specific disease table 1. As with most drug induced diseases, the pathological changes are nonspecific. Pepper professor of public health and preventive medicine professor of biostatistics and epidemiology, medicine, and pharmacology vice dean for institutional affairs university of pennsylvania.
Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes disorders. Perazella abstract drugs and toxins frequently are associated with the development of various types of acute kidney disease and ckd. Drug induced acute renal dysfunction karen shalansky, pharm. 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. A list of kidney diseases this is a list of diseases of the kidney and urinary tract, both common and rare, for patients and physicians. 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. Identify the components of the history required to rule inout a drug causation. Decreased urination, hypervolemia edema, n, loss of appetite, malaise, confusion, scr may lag behind renal damage by 12 days preventing di aki avoid nephrotoxic drugs in patients with risk factors for aki.
Cite the risk factors for aminoglycoside and radiocontrast induced nephrotoxicity. Drug induced liver and kidney injuries are the most common adverse drug reactions in the clinic, and they have similar pathogeneses. The national kidney disease education program of the national institute of diabetes and diseases of the kidney, national kidney. Drug dosing adjustments in patients with chronic kidney. Druginduced kidney disease free download as powerpoint presentation. Ag induced acute renal failure is generally nonoliguric, and may be associated with decreasedurineconcentratingabilityand urinary magnesium wasting. 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. Get a printable copy pdf file of the complete article 687k, or click on a page image below to browse page by page.
This booklet has been compiled to improve the management of rash, renal injury and drug induced liver injury in adult patients on tb treatment andor antiretroviral therapy. Dec 10, 20 possible causes for this storage disorder encompass fabrys disease, in rare cases silicosis, and an iatrogenic drug induced aetiology. Risk of drug nephrotoxicity is increased in the patient with aki or chronic kidney disease ckd. Drug induced kidney disease occurs primarily in patients with underlying risk factors.
Nonsteroidal antiinflammatory drug induced acute kidney. Sign in with your ashp username and password to access purchased ebooks in my library. 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 tract obstruction with kidney injury 45. The true incidence of druginduced acute and chronic interstitial nephritis is probably. Druginduced renal disorders journal of renal injury prevention. The hypersensitivity to drug induced renal toxicity is accompanied by increases in circulating drug levels. 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. Longterm cocaine use can lead to chronic renal failure. Management of suspected drug induced rash, kidney injury. 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. Apr 09, 2020 hivassociated nephropathy and drug induced renal injury.
Druginduced 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. Patients at highest risk of drug induced nephrotoxicity are those with one or more of the following. Compare and contrast acute tubular necrosis and acute allergic interstitial nephritis. 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. 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. Interpret the findings for potential drug induced renal damage, complications from chronic diseases such as hypertension and diabetes mellitus and the presence or absence of other common renal. Renal phospholipidosis possibly induced by ranolazine. 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.
Ppt druginduced kidney disease powerpoint presentation. Endstage renal disease drug induced renal mass renal failure, nephrotoxicity, drugs 1. Pdf druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice find. Acute kidney injury and chronic kidney disease hiv infection is associated with an almost fourfold increased risk of renal disease, attributable to a variety of causes of aki as well as chronic kidney disease ckd. Although medications are a widely known cause of tubulointerstitial damage, drug related glomerular. Since it is virtually impossible to distinguish an iatrogenic drug induced pl from fabrys disease on ultrastructural analysis of kidney tissue, the clinician has to use the patients family history, extra renal symptoms, and biochemical features, such as a reduced.
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. With the upward trend of prescription and overthecounter medication use, it has become increasingly important for health care professionals to not only be able to identify acute renal failure precipitated by medications, but also to recognize medications that are eliminated by the kidneys and. Druginduced kidney disease annals academy of medicine. The purpose of this report is to clarify drug induced kidney disease dikd of renal biopsied cases in japan. These novel findings demonstrate deficiency of renal function in mice with globally reduced por expression and suggest that low por expression may be a risk factor for drug induced nephrotoxicity in humans. The drug may be filtered or secreted into the lumen of the renal tubules.
Proximal tubular vacuolization and hypersensitivity to drug. 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. Drug dosing adjustments in patients with chronic kidney disease. 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 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. The manifestations of drug induced pulmonary diseases span the entire spectrum of pathophysiologic conditions of the respiratory tract. Get a printable copy pdf file of the complete article 755k, or click on a page image below to browse page by page. Cocaine use can cause renal artery thrombosis clotting, severe hypertension and interstitial nephritis. From there, you can view and download your ashp ebooks to the reader of your choice.
Despite best efforts to assure that all drugs are safe and effective, millions of patients each year develop drug induced diseases. Hivassociated nephropathy hivan is a kidney disease often seen in intravenous drug users afflicted by hiv 2. Sep 01, 2015 drug induced renal disorders are more common in certain patients and in specific clinical situations. C 7, 10, 32, 48 druginduced renal impairment is generally reversible, provided the nephrotoxicity is recognized early and the offending medication is discontinued. Identify an approach to incorporating did wi the differential. 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. Identify risk factors for high probability did causation. Full text druginduced impairment of renal function ijnrd. Drug induced renal disease identifying drug induced aki drug induced to be shorted to di sx.
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. Full text full text is available as a scanned copy of the original print version. The true incidence of drug induced acute and chronic interstitial nephritis is probably. Early detection of drugs adverse effects is important to prevent progression to endstage renal disease. Acute renal failure in patients with drug induced acute interstitial nephritis. Renal disease induced by drugs was studied by percutaneous biopsy in 40 patients. 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. Some drugs induce renal injury in the context of a systemic syndrome.
Approach to acute kidney injury in hivinfected patients. For most drugs, preexisting liver dysfunction does not generally increase the risk of developing drug induced liver disease, although sodium valproate and methotrexate are notable exceptions. Why is the kidney at risk for drug induced diseases. Nonsteroidal antiinflammatory drugs nsaids are a common cause of adverse drug events ades, but renal risks of nsaids are less well quantified than gastrointestinal and cardiac risks. Therefore, early detection of drugs adverse effects is. Drugs triamterene, sulfadiazine acetylsulfadiazine crystalluria, indinavir, antiviral drugs. Drug induced nephrotoxicity is a common yet preventable cause of acute renal failure. 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. Similar drugs exhibit similar features, class effects 4. Dec 12, 2014 overview of drug induced renal impairment.
Acute renal failure arf l an abrupt or rapid decline in renal function l marked by a rise in bun azotemia or serum creatinine concentration l immediately after a kidney injury, bun or creatinine levels may be normal. Munar, pharmd, bcps, and harleen singh, pharmd oregon state university college of pharmacy, portland, oregon. The only cationic amphiphilic drug our patient had taken was the antianginal ranolazine, a compound not yet associated with pl. In some cases, this condition can progress to endstage kidney failure. Drug induced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. Liver and renal disease patient assessment in pharmacy.
Drug induced renal disease is common and responsible for a variety of pathological effects on the kidney, many of which are potentially recoverable. Druginduced acute renal dysfunction karen shalansky, pharm. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain stereotyped renal responses. Certain drugs eg, diuretics, antidepressants, and antiepileptics. The main suspects are cationic amphiphilic drugs, such as amiodarone and chloroquine. Druginduced acute kidney injury in children faught 2015. If youre interested in a basic introduction to the kidneys instead, please click here. 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.
Druginduced kidney disorder disease dkid is an origin of kidney disease followed by acute renal failure. Drug dosing adjustments in patients with chronic kidney disease myrna y. Nonsteroidal antiinflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease. Drug induced kidney disease is associated with increases in mortality, length of stay, and healthcare costresources. Longterm tobacco use also increases the risk of kidney cancer. Drug induced kidney injury is a frequent adverse event which contributes to morbidity and increased healthcare utilization.
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