Specific examples of patients with drug induced diseases. Druginduced kidney diseases np singh, a ganguli, a prakash abstract druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. Pharmacology behind common drug nephrotoxicities american. Renal vulnerability to drug toxicity nephrology selfassessment program vol 9, no 4, july 2010 clin j am soc nephrol 4. This article provides a summary of the most common mechanisms of drug induced nephrotoxicity and prevention strategies.
An overview of drug induced acute kidney injury neesh pannu, md, sm, frcp. Perazella, md, facp associate professor of medicine director, renal fellowship program yale university school of medicine. State the drug induced renal structuralfunctional alterations observed, and provide examples of each. 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. Prior to 2002, the incidence of acute renal failure arf varied as there was no standard definition. Mehta2 abstract drug induced kidney injury is a frequent adverse event which contributes to morbidity and increased healthcare utilization. There are also reports of chip models combining liver and kidney cells. Understanding the mechanism of drug induced renal damage helps to decide. Management of drug induced liver injury is symptomatic, with early referral to a liver transplant unit at the first hint of liver. Furthermore, the tubulointerstitium is not the only renal compartment involved with this type of injury.
Chair and professor, department of biostatistics and epidemiology director, center for clinical epidemiology and biostatistics george s. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain stereotyped renal responses. Since the first edition of this book was published in 2005, numerous drugs have been withdrawn from the market in the united states as a result of morbidity andor mortality associated with drug induced diseases. Drug induced kidney injury is a frequent adverse event which contributes to morbidity and increased healthcare utilization. The true incidence of drug induced acute and chronic interstitial nephritis is probably underestimated as interstitial nephritis is a nonspecific finding in chronically scarred kidneys. 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. Druginduced acute renal dysfunction karen shalansky, pharm.
Druginduced kidney disease 1 druginduced kidney disease 2 introduction. Druginduced renal disorders journal of renal injury prevention. 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. Any stimuli that induce loss of these cells can induce kidney damage and renal failure. Drug induced kidney disease 1 drug induced kidney disease 2 introduction. The drug induced renal injury consortium direct the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. In a case of undiagnosed renal disease a possibility of druginduced renal failure should be kept as the prompt removal of the drug and supportive management can reverse the renal dysfunction to. The pathogenesis of druginduced renal cystic disease. 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. Diagnosis of drug induced liver diseases can be difficult, but the key to causality is to diligently exclude other causes of liver injury, and to identify a characteristic clinical drug related signature.
Sep 01, 2015 drug induced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Chronic tubulointerstitial nephritis and nephritis of unknown origin account for 15 to 30 percent of the cases of endstage renal disease esrd in the united states and europe. Identify an approach to incorporating did wi the differential. The exact frequency of nephrotoxicity induced by antiviral drugs is difficult to determine. Druginduced renal toxicity is more common in infants and young children in certain.
Markowitz and others were the first to report the association between pamidronate and collapsing glomerulopathy. Ashp ebooks sign in with your ashp username and password to access purchased ebooks in my library. Drug induced kidney disorder disease dkid is an origin of kidney disease followed by acute renal failure. She received everolimus due to disease progression after sunitinib, but 2 months after starting everolimus treatment, she visited the emergency department after developing a sudden fever and dyspnea. Druginduced renal disease diagnostic histopathology. Kidneybased in vitro models for druginduced toxicity testing. In addition, drug induced kidney injury, especially of patients in intensive care units.
Drug induced renal toxicity is more common in infants and young children in certain. Patients at highest risk of drug induced nephrotoxicity are those with one or more of the following. Drug induced impairment of renal function george sunny pazhayattil, anushree c shirali section of nephrology, yale university school of medicine, new haven, ct, usa abstract. Compare and contrast acute tubular necrosis and acute allergic interstitial nephritis. The national kidney disease education program of the national institute of diabetes and diseases of the kidney, national kidney. We describe an 81yearold woman with metastatic renal cell carcinoma who did not recover from lifethreatening interstitial pneumonitis induced by everolimus therapy.
Despite best efforts to assure that all drugs are safe and effective, millions of patients each year develop drug induced diseases. Drug induced pseudorenal failure bun due to protein catabolism steroids, tetracyclines scr due to competitive inhibition of creatinine secretion trimethoprim, cimetidine, triamterene with trimethoprim 1535% rise scr fully expressed after 3 days more sig in pts with preexisting renal dysfunction can occur with normal doses completely. Ppt druginduced kidney disease powerpoint presentation. When these changes become persistent both in structure and function, aki may progress to chronic kidney disease ckd, and when not properly. Druginduced renal disease is common and responsible for a variety of pathological effects on the kidney, many of which are potentially recoverable. 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. Our current knowledge of drug induced kidney disease is limited due to varying definitions of kidney. The pathogenesis of drug induced renal cystic disease. Diagnosis, management and prevention of druginduced liver injury. Druginduced kidney disorderdisease dkid is an origin of kidney disease followed by acute renal failure. Electronic surveillance presents a powerful tool to identify susceptible. The drug induced renal injury consortium full text view. Most of these markers deliver information only when renal damage is well. Druginduced kidney disease kidney kidney disease free.
Identify risk factors for high probability did causation. Druginduced encephalopathy secondary to non renal dosing of. Cite the risk factors for aminoglycoside and radiocontrast induced nephrotoxicity. 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. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Being on the front lines of patient care as well as pharmacotherapy, healthcare professionals need to be knowledgeable regarding the risk of druginduced diseases, including methods of detection, prevention, and management. The role of medications and their management in acute kidney injury bradford l mcdaniel,1 michael l bentley1,2 1department of pharmacy, carilion clinic, roanoke, va, usa. Full text the role of medications and their management in. It is therefore vital in any patient with renal disease whatever the. Identify the laboratory tests required to rule inout as drug induced causation. Drug induced nephrotoxicity is a common problem in clinical medicine and the incidence of drug related acute kidney injury aki may be as high as 60 percent 14. Nov 21, 2015 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.
The kidney maintains the vital functions of clearing excess body fluid and removing metabolic and exogenous toxins from the blood. Case reports in urology hindawi publishing corporation. Druginduced kidney disease pathology and current concepts. Full text druginduced impairment of renal function ijnrd. The 6rs of drug induced nephrotoxicity bmc nephrology. Overview of drug induced renal impairment 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.
Drug induced kidney diseases authorstream presentation. She was not told that the drug was not approved by the fda for her condition. Oral administration of 2amino4,5diphenyl thiazole hcl to rats over a period of 11 weeks produced marked, diffuse, progressive renal cystic disease without significant tubular obstruction or interstitial fibrosis. Pathogenesis, diagnosis, and acute liver failure the postgraduate course at this years meeting of the american association for. Adjustment of several drugs administered to dialysis patients is mandatory because of decreasedand sometimes totally absentrenal clearances. The 6rs of drug induced nephrotoxicity linda awdishu1,2 and ravindra l. Listing a study does not mean it has been evaluated by the u. Munar, pharmd, bcps, and harleen singh, pharmd oregon state university college of pharmacy, portland, oregon.
Druginduced renal disorders are more common in certain patients and in specific clinical situations. 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. Drugs can cause acute renal injury, intra renal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes disorders. Drugs known to be nephrotoxic include several cancer therapeutics, drugs of abuse, antibiotics, and radiocontrast agents. Drug induced kidney disease is associated with increases in mortality, length of stay, and healthcare costresources. It accounts for more than 2% to 15% of cases of arf in patients admitted to the hospital or in the intensive care unit, respectively. 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. Pharmaceutical agents provide diagnostic and therapeutic utility that are central to patient care. 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.
Renal disease, then, has the potential to alter not only the renal clearance of unchanged drug but also may substantially modify the metabolic transformation of drugs in both the liver and the kidneys. From there, you can view and download your ashp ebooks to the reader of your choice. Hivassociated nephropathy and druginduced renal injury. Antiviral druginduced nephrotoxicity american journal of. Patients at highest risk of druginduced nephrotoxicity are those with one or more of the following. Drug dosing adjustments in patients with chronic kidney disease myrna y. Renal dysfunction and renal disease due to drugs are common and can lead to renal failure, both acute and chronic. Hepatic failure is a particular risk factor for druginduced renal impairment. Medcram medical lectures explained clearly 543,516 views 15. Feb 22, 2016 acute kidney injury acute renal failure explained clearly bun creatinine ratio duration.
The condition can be costly and may require multiple interventions, including hospitalization. The purpose of this report is to clarify drug induced kidney disease dikd of renal biopsied cases in japan. Nolin key concepts the initial diagnosis of drug induced kidney disease dikd typically involves detection of elevated serum creatinine and blood urea nitrogen, for which there is a temporal relationship between the toxicity and use of a potentially nephrotoxic drug. Identify the components of the history required to rule inout a drug causation. Druginduced kidney disease free download as powerpoint presentation. These factors combine to increase patient exposure to excess drug concentrations and nephrotoxicity risk. Pdf on jan 24, 2019, azade sari and others published nephrotoxic effects of drugs find, read and cite all the research. 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. Druginduced encephalopathy secondary to non renal dosing of common medications in two dialysis patients the u.
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. While most of these are clinically insignificant, some drugs. Druginduced nephrotoxicity is a renal dysfunction that occurs as a result of exposure to. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain. Druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice.
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. 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. Liz, a 54year old woman, was prescribed the heart drug amiodarone cordarone to treat a common heart condition. Drug induced nephrotoxicity tends to occur more frequently in patients. List the drugs most commonly implicated in acute tubular necrosis. Pdf druginduced kidney disease pathology and current. Comorbid conditions such as liver disease, heart disease, and ckd. Biomarkers for druginduced renal damage and nephrotoxicity.
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