Some drugs are ineffective when renal function is reduced. Jul 28, 2017 drug induced kidney disease dikd is a significant contributor of acute kidney injury aki and chronic kidney disease ckd. Druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. 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.
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. Markowitz and others were the first to report the association between pamidronate and collapsing glomerulopathy. Apr 03, 2017 drug induced kidney injury is a frequent adverse event which contributes to morbidity and increased healthcare utilization. The clinical manifestations of druginduced 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. Although it is the primary therapeutic option at present, transplanted patients have to deal with the numerous side effects of infusion of thirdparty mesenchymal stem cells msc after kidney and liver transplantation. Most prominent are the arteritis, glomerulonephritis, tubular necrosis, renal cortical necrosis, intratubular crystal deposition, acute and chronic interstitial fibrosis, interstitial granulomas and acute renal insufficiency with normal. Role of mineralocorticoid receptor antagonists in kidney. 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. Mar 19, 2010 chronic kidney disease ckd affects many people in the united states, and more than 500,000 americans have endstage renal disease esrd requiring dialysis. It is usually not a problem unless scr increases over 30%. Drug induced kidney disease dikd is a significant contributor of acute kidney injury aki and chronic kidney disease ckd. From bedside to bench druginduced tubulointerstitial disease.
Mr antagonists mras have demonstrated therapeutic actions in chronic kidney disease ckd, diabetic nephropathy dn, renal fibrosis, and drug. Ppt druginduced kidney disease powerpoint presentation. Drug induced kidney disease is a frequent cause of renal dysfunction. Pdf druginduced kidney disease pathology and current. Prescribing drugs in kidney disease clinical nephrotoxins.
Drug induced renal toxicity is more common in infants and young children in certain. Druginduced kidney disease pathology and current concepts. Features and management of druginduced renal failure. Acute kidney injury aki is associated with a high hospitalization rate, accelerated longterm decline in kidney function and a high mortality rate. Kidneybased in vitro models for druginduced toxicity. The incidence of drug induced nephrotoxicity is 1426% in adults and 16% in paediatric cases 1. Feb 01, 2007 renal dysfunction and renal disease due to drugs are common and can lead to renal failure, both acute and chronic. Druginduced nephrotoxicity american academy of family. Druginduced diseases are primarily diagnosed based on the history of drug intake obtained from the patient or the family. Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes disorders. Patients with oliguric renal failure seem to do worse than those with nonoliguric renal failure, or only mild uremia, as do those with dtffuse. Certain drugs can cause alteration in intraglomerular hemodynamics, inflammatory changes in renal tubular cells, leading to acute kidney injury. They are broadly categorized as patientspecific, kidney related, and drug related factors.
Electronic surveillance presents a powerful tool to identify susceptible. The 6rs of drug induced nephrotoxicity bmc nephrology. Druginduced renal disease is common and responsible for a variety of pathological effects on the kidney, many of which are potentially recoverable. These drug induced glomerular diseases should be part of the differential diagnosis in patients presenting with proteinuria, hematuria, andor renal insufficiency. Druginduced renal disease prevention strategies association of. Most studies of drug induced aki have focused on a sole drug. Drug induced lung disease may occur via various mechanisms. Chronic drug induced renal damage o cyclosporine o aristolochic acid nephropathy o warfarin o takaout.
Organ transplantation is the only definite treatment of many critical diseases of the liver, kidney, heart, pancreas and lung. Although large clinical studies and postmarketing data support a benign renal profile for tenofovir. From bedside to bench druginduced tubulointerstitial. 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. 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 obstructive. These medications can cause drug induced kidney disease dikd aceiarb.
Drug induced acute renal dysfunction karen shalansky, pharm. Drug induced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. Oct 29, 2019 impaired renal function is commonly observed in clinical practice and is often associated with the use of drugs. Rifampicininduced nephrotoxicity in a tuberculosis patient. 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.
Recognition of a drug induced etiology and withdrawal of the offending agent provide the best hope for renal recovery. The aim of this article is to discuss the pathological features of drug induced renal disease as diagnosed by kidney biopsy. The drugs that mostly frequently induce acute kidney. Improving global outcomes guidelines, aki is an increase in scr by 0.
Rifampicin is a commonly used and effective drug to treat tuberculosis tb. One, two, or all three of the factor categories can act to promote various forms of renal injury. Therefore, early detection of drugs adverse effects is important to prevent progression to endstage renal disease. Patients with ckd are at increased risk for cardiovascular disease and complications. The kidneys can be damaged by a large number of therapeutic agents. Drug induced kidney diseases nonsteroidal anti inflammatory. As a consequence, the prevalence and incidence of the majority of adverse effects of drugs, such as dili, are still only partially known. Nonsteroidal antiinflammatory drug induced acute kidney. This article considers the different types of acute renal failure and the drugs commonly implicated. Ag induced acute renal failure is generally nonoliguric, and may be associated with decreasedurineconcentratingabilityand urinary magnesium wasting. Drug induced nephrotoxicity is a common problem in clinical medicine and the incidence of drug related acute kidney injury aki.
Drug induced kidney disorder disease dkid is an origin of kidney disease followed by acute renal failure. Druginduced kidney disease is the property of its rightful owner. Overview of key mechanisms involved in drug induced. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain stereotyped renal responses. The drugs that mostly frequently induce acute kidney injury.
Sep 15, 2008 drugs cause approximately 20 percent of communityand hospitalacquired episodes of acute renal failure. Phenotype standardization for druginduced kidney disease. Most studies of drug induced aki have focused on a sole drug class. Scribd is the worlds largest social reading and publishing site. Patients at highest risk of drug induced nephrotoxicity are those with one or more of the following. Network akin diagnostic criteria and the risk, injury, failure, loss, and endstage renal disease esrd rifle classification table 1. Practical assessment tools for identifying kidney disease. Drug induced kidney disorder disease dikd is an origin of kidney disease followed by acute renal failure. The symptoms should appear at a reasonable time frame after taking the. Drug induced ain 805 discussion the immunogenicity of native renal proteins fig. Renal vulnerability to drug toxicity american society of. The term aki has replaced acute renal failure because smaller changes in kidney function without overt fail ure can result in significant clinical consequences and increased. The alterations were correlative and interactive to each other. Renal pathophysiology the essentials 5th edition pdf free download renal pathophysiology can be a difficult subject even for the most advanced medical students.
The comprehension of the effect of csa in renal epithelial cells gives us more insight in understanding drug induced renal tubulointerstitial disease. 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. The initial diagnosis of drug induced kidney disease dikd typically involves detection of. The essentials provides an easytoread, casebased approach to learning the mechanisms of renal disease. The purpose of this report is to clarify drug induced kidney disease dikd of renal biopsied cases in japan. Features of acute kidney injury consist of rapid over hours to days and usually reversible decrease in kidney function, commonly in the setting of surgery, severe infection, injury or drug induced kidney toxicity. It is therefore vital in any patient with renal disease whatever the. Mechanisms of druginduced acute and chronic renal damage. Drug induced kidney disease alwin hl loh and arthur h cohen cellular, tip and collapsing. Sensitivity to some drugs is increased, even if elimination is unimpaired.
Perazella 1 t enofovir, used in combination with other antiretroviral agents, is an effective therapy for hiv infection. Druginduced renal disorders journal of renal injury. Role of mineralocorticoid receptor antagonists in kidney diseases. Drug induced nephrotoxicity tends to occur more frequently in patients. Druginduced kidney disease kidney kidney disease free. 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. Here are five things healthcare professionals should know about drug induced kidney injuries. Rifampicininduced nephrotoxicity in a tuberculosis. Renal disease is almost always reversible after withdrawal of drug therapy, but some patients continue in renal failure for prolonged period after withdrawal and a few suffer perma nent renal damage. Onethird of all drugs and drug candidates are excreted unchanged from the body by the kidneys, and drug induced nephrotoxicity accounts for 20% of all episodes that lead to acute kidney failure naughton 2008b.
The pathogenesis of druginduced renal cystic disease. Drug induced kidney diseases free download as powerpoint presentation. Acute kidney injury aki results in the abrupt loss of kidney function, leading to the retention of waste products, electrolyte disturbances, and volume status changes. Pdf druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice find. The renal drug handbook 5th edition medicina interna. The causative drug must be identified and its use must be. Druginduced renal disease identifying druginduced aki drug induced to be shorted to di sx. Certain drugs can cause alteration in intraglomerular hemodynamics. Clinical evidence of ag induced acute tubular necrosis is seen within 5 to 10 days of initiation of ag treatment.
This usually takes time before it manifests clinically. 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. Screen patients for acute kidney injury and other conditions that may reduce renal function. Druginduced renal disorders journal of renal injury prevention. An overview is presented of the morphologic patterns associated with drug or toxin induced renal lesions.
Oral administration of 2amino4,5diphenyl thiazole hci to rats over a period of 11 weeks produced marked, diffuse, progressive renal cystic disease without significant tubular obstruction or interstitial fibrosis. Adverse drug reactions adrs constitute one of the most important modi. Histopathology of drug and toxin induced kidney lesions. Sep 15, 2008 patients at highest risk of drug induced nephrotoxicity are those with one or more of the following. Drug induced kidney disease free download as powerpoint presentation. Acute kidney injury aki may occur 3 to 16 months after cpi exposure, which makes extended renal. Although it is impossible to present all the drugs causing renal disease, a few prototype drugs are mentioned. Drug dosage adjustment for patients with acute or chronic kidney disease is an accepted standard of practice. Nonsteroidal antiinflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease. The toxic effect is usually dose related, though other factors such as age and renal function can enhance toxicity. 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. A number of factors enhance the vulnerability of the kidney to the nephrotoxic effects of drugs and toxins. Renal pathophysiology the essentials 5th edition pdf free.
278 1249 1062 1241 1011 474 1497 980 319 570 317 1148 1569 252 1282 1605 407 541 681 574 1205 956 1530 1593 1294 841 944 631 427 428 652 475 781 330