How to prevent, recognize, and treat drug-induced nephrotoxicity.

Abstract

Many drugs can injure the kidneys, but they cause renal injury via only a few common mechanisms. Many patients who develop renal injury after drug exposure have identifiable risk factors that could be modified or that should preclude the use of these drugs in the first place. s KEY POINTS Pretreatment hydration can reduce the nephrotoxic potential of many drugs. Renal injury can present as acute renal failure, nephrotic syndrome, renal tubular dysfunction, or chronic renal failure. Early diagnosis is critical; therefore, physicians must be aware of the nephrotoxic potential of the medications they prescribe and the risk status of their patients. One must anticipate the problem and exclude drugs as possible causes of renal disease when no other obvious cause can be found. DRUG-INDUCED NEPHROTOXICITY GUO AND NZERUE Prophylaxis of druginduced renal failure Amphotericin B Adjust dosage Hydrate with normal saline infusion Use liposomal formulation Aminoglycosides Follow levels Correct potassium levels Give once-daily doses Adjust dosage for renal function Avoid use if possible in high-risk patients Possibly give calcium channel blockers Intravenous contrast Hydrate with normal saline infusion Possibly give acetylcysteine Cisplatin Hydrate with normal saline Possibly give thiosulfate ACE inhibitors Avoid in bilateral renal artery stenosis Use with caution in hypovolemia Acyclovir Avoid bolus doses Give intravenous fluids Adjust dose for renal function Lithium Monitor levels Amiloride may prevent nephrogenic diabetes insipidus Interleukin-2 Intravenous saline, albumin infusion Cyclosporine Follow levels Avoid drugs that raise levels (erythromycin, verapamil, ketoconazole) Indinavir Hydrate Establish high urine flow * ACE-angiotensin-converting enzyme COX-cyclo-oxygenase NSAID-nonsteroidal anti-inflammatory drug TTP-HUS-thrombotic thrombocytopenic purpura-hemolytic uremic syndrome

Paracetamol Overdose Induces Physiological and Pathological Aberrations in Rat Brain

“…A major problem is the misuse of paracetamol through intentional or unintentional uptake of supratherapeutic doses, which may lead to hepatic and renal adverse side effects in humans and experimental animals (Guo and Nzerue 2002;Toklu et al, 2006). Paracetamol is metabolized mainly in the liver via conjugation with glucuronic acid and sulphate, and finally excreted in urine.…”

Síndrome hemolítico urémico atípico, revisión de la literatura y documento de consenso. Enfoque diagnóstico y tratamiento

“…existen ciertas categorías de medicamentos implicadas en el desarrollo de la MAT a través de una toxicidad directa a las células endoteliales 21,22 . Los inhibidores de la calcineurina y algunos agentes quimioterapéuticos pueden inducir activación endotelial y causar MAT auto limitada (MAT inducida por el medicamento) pero también pueden ser el desencadenante de un SHUa de base.…”

Renal Vulnerability to Drug Toxicity

“…Many of these factors are nonmodifiable, such as older age and female gender. Risk in the elderly and females occurs through the following: 1) changes in total body water, which is reduced in setting of decreased lean body mass and leads to drug overdose; 2) unrecognized lower GFR despite normal serum creatinine concentration; and 3) reduced drug binding to proteins due to hypoalbuminemia, which results in increased free drug concentrations (17)(18)(19)(20). The elderly also have increased propensity to vasoconstriction from excessive angiotensin II and endothelin and have higher levels of oxidatively modified biomarkers (17).…”