Nephrology Book

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Nephrotoxic DrugsAka: Drug-induced Nephrotoxicity

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  1. See Also
    1. Acute Tubulointerstitial Nephritis for drug causes
  2. Risk Factors for nephrotoxicity
    1. See Nephrotoxicity Risk
  3. Causes: Antibiotics
    1. Aminoglycosides (10-15% Incidence of Acute Tubular Necrosis)
      1. Occurs in 10-20% patients on 7 day course
      2. Results in non-oliguric increased Creatinine
      3. A single dose early in septic course is usually safe
    2. Sulfonamides
    3. Amphotericin B (Incidence 80-90%)
    4. Levofloxacin
    5. Ciprofloxacin
    6. Rifampin
    7. Tetracycline
    8. Acyclovir (only nephrotoxic in intravenous form)
    9. Pentamidine
  4. Causes: Chemotherapy and Immunosuppressants
    1. Cisplatin
    2. Methotrexate
    3. Mitomycin
    4. Cyclosporine
  5. Causes: Heavy Metals
    1. Mercury Poisoning
    2. Lead Poisoning
    3. Arsenic Poisoning
    4. Bismuth
    5. Lithium related kidney disorders
      1. Polydipsia and Nephrogenic Diabetes Insipidus
      2. Acute Renal Failure
        1. Dialysis indications: Creatinine >2.5 or Seizures, ALOC, Rhabdomyolysis
      3. Chronic Kidney Disease with fibrosis
  6. Causes: AntiHyperlipidemics
    1. Statin Drugs
    2. Gemfibrozil
      1. Associated with Acute Renal Failure due to Rhabdomyolysis
    3. Fenofibrate (Tricor)
      1. Increases Serum Creatinine without significant decrease in GFR
      2. Serum Creatinine rise is reversible on stopping Fenofibrate
  7. Causes: Chemotherapy
    1. Cisplatin
    2. Ifosphamide
      1. Causes Fanconi's Syndrome
  8. Causes: Miscellaneous Drugs
    1. Chronic Stimulant Laxative use
      1. Resulting chronic volume depletion and Hypokalemia causes nephropathy
    2. Radiographic contrast
      1. See Intravenous Contrast Related Acute Renal Failure
    3. ACE Inhibitors
      1. Expect an increase of Serum Creatinine in Chronic Kidney Disease
      2. See ACE Inhibitors for guidelines on Serum Creatinine rise that warrants stopping medication
    4. NSAIDs
        1. See Nephrotoxicity due to NSAIDs
    5. Aspirin
      1. Low dose Aspirin reduces Renal Function in elderly
        1. Decreased Creatinine Clearance after 2 weeks of use
        2. Changes persisted for at least 3 weeks off Aspirin
        3. Segal (2003) Am J Med 115:462
    6. Mesalamine (Asacol, Pentasa)
      1. Mesalamine is an NSAID analog and has systemic absorption from the bowel
      2. See Nephrotoxicity due to NSAIDs
  9. Causes: Drugs of abuse
    1. Cocaine
  10. References
    1. Thatte (1996) Postgrad Med 100(6):83

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