<p>Isotretinoin and the Kidney: Opportunities and Threats</p>

Abstract

Retinoids are one of the most effective drugs in inducing complete or prolonged remission of severe acne vulgaris, but the adverse reactions associated with the use of them are raising a concern about the potential effect of these drugs on internal organs function such as the kidney. The aim of this review is to comprehensively gather data about isotretinoin, both potential adverse and beneficial effects on the kidney based on the current experimental and clinical findings. Very few studies, including five case reports, described that systemic oral isotretinoin within usual doses (40 mg/day or 0.5 mg/kg⁄day) within 1 to 4 months of treatment might be associated with different types of renal dysfunctions. These include acute interstitial nephritis, nephrotic syndrome, and hematuria with dysuria. The adverse reactions of systemic isotretinoin on the kidney and urinary system are unlikely and rare. In contrast, six experimental studies demonstrated the beneficial effects of either oral or parenteral low-(2 or 5 mg/kg/day) or high-(10, 20, 25, 40 mg/kg/day) dose isotretinoin on the kidney in the rat models of glomerulonephritis, obstructive nephropathy or allograft nephropathy. The nephroprotective functions of isotretinoin in these studies were attributed to its anti-proliferative, anti-fibrotic, and anti-inflammatory actions. However, clinical studies are warranted to elucidate the possible beneficial effects of isotretinoin in preventing or attenuating kidney injury in different settings.

Isotretinoin Associated Rhabdomyolysis: Monitoring Creatine Kinase and Educating Patients

“…If patients develop AKI due to rhabdomyolysis, we suggest monitoring BUN, creatinine, and CK levels before initiating/restarting treatment as there have been 5 case reports of isotretinoin-induced AKI in the forms of acute interstitial nephritis, nephrotic syndrome, and hematuria with dysuria. All of these cases endorsed the resolution of AKI with the cessation of isotretinoin and appropriate resuscitation and management [16][17][18]. Although retinoids have been shown to reduce damage and inflammation in experimental models of glomerulonephritis and renal interstitial disease, paradoxically, isotretinoin's xerotic mucosal side effects have been described to cause hematuria [18].…”

How safe and effective is prescribing oral isotretinoin to treat acne in patients on renal dialysis? A systematic review

“…Although there have been reservations about the use of isotretinoin in patients on renal dialysis because of apprehensions regarding potential adverse effects, the drug has been reported to have been safely and successfully used in several cases. In fact, isotretinoin has nephroprotective effects in glomerulonephritis, obstructive nephropathy and allograft nephropathy, owing to its antiproliferative, anti‐inflammatory and antifibrotic actions 2 . We report the findings from our systematic review of the literature surrounding the use of isotretinoin in patients on renal dialysis.…”

“…In fact, isotretinoin has nephroprotective effects in glomerulonephritis, obstructive nephropathy and allograft nephropathy, owing to its antiproliferative, anti-inflammatory and antifibrotic actions. 2 We report the findings from our systematic review of the literature surrounding the use of isotretinoin in patients on renal dialysis.…”

A conscious minimally invasive approach to remove follicular cysts and infundibular keratinizing acanthomas in five dogs

“…Current treatment options include benign neglect, surgical excision, cryotherapy, carbon dioxide laser ablation, retinoids (used mainly when surgical intervention is not feasible) and extrusion of contents 3–6 . Each has potential disadvantages, including risks of general anaesthesia, time for wound healing, discomfort, risk of cosmetic complications, and potential systemic adverse effects on the patient or its owner (retinoids) 5–7 . Certain therapies may require repeated administration, and tumour recurrence/persistence may occur if any portion of tumour capsule remains after therapy 5,6 …”

“…[3][4][5][6] Each has potential disadvantages, including risks of general anaesthesia, time for wound healing, discomfort, risk of cosmetic complications, and potential systemic adverse effects on the patient or its owner (retinoids). [5][6][7] Certain therapies may require repeated administration, and tumour recurrence/persistence may occur if any portion of tumour capsule remains after therapy. 5,6 In humans, a similar benign tumour type is called an epidermoid cyst.…”