Nephrology and renal diseases is an open access journal and we do not charge the end user when accessing a manuscript or any article. 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. Patients at highest risk of druginduced nephrotoxicity are those with one or more of the following. 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. Drug induced kidney disease can occur due to patient related factors and in specific disease table 1. Druginduced kidney disease kidney kidney disease free. Chair and professor, department of biostatistics and epidemiology director, center for clinical epidemiology and biostatistics george s.
Conversely, kidney failure affects general immunity, causing intestinal barrier dysfunction, systemic. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain. Renal, or kidney, failure may occur as a result of taking various kinds of medication, including both prescription and overthecounter drugs. Prevention, detection, and management begin by defining druginduced disease did as, an unintended effect of a drug that may result in morbidity or mortality with symptoms sufficient to prompt a patient to seek medial attention andor require hospitalization. Druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Why is the kidney at risk for drug induced diseases.
Druginduced renal disease can mimic renal disease from other causes, such as autoimmune disease and infection a thorough physical examination and medical history should be performed increase in serum creatinine and bun. 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. A collapsing form of focal segmental glomerulosclerosis fsgs has been considered the primary form of hivrelated renal disease, with up to 60% of renal biopsies showing this lesion. It is therefore vital in any patient with renal disease whatever the. Drugs can cause acute renal injury, intra renal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes disorders.
Jun 09, 2014 the drug induced renal injury consortium direct the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. 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. A definitive guide to drug induced disease now in its third edition, this comprehensive guide provides a detailed overview of diseases that result from drug therapy, arming healthcare professionals with critical knowledge to protect the health and welfare of their patients. Dec 10, 20 since it is virtually impossible to distinguish an iatrogenic druginduced pl from fabrys disease on ultrastructural analysis of kidney tissue, the clinician has to use the patients family history, extrarenal symptoms, and biochemical features, such as a reduced. Patient specific disease specific age older than 60 years diabetes genetic variation in cyp3a4, mdr1, ace, tgf. 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. Compare and contrast acute tubular necrosis and acute allergic interstitial nephritis. Cite the risk factors for aminoglycoside and radiocontrast induced nephrotoxicity. Pepper professor of public health and preventive medicine professor of biostatistics and epidemiology, medicine, and pharmacology vice dean for institutional affairs university of pennsylvania. The drug induced renal injury consortium full text view. Introduction 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.
Drug induced kidney disease is associated with increases in mortality, length of stay, and healthcare costresources. Overview of management of acute renal failure and its evaluation. Druginduced nephrotoxicity is a common problem in clinical medicine and the incidence of drugrelated acute kidney injury aki may be as high. Sep 01, 2015 drug induced renal disorders are more common in certain patients and in specific clinical situations. Infection induced kidney diseases are of concern for clinicians because timely detection and treatment of infections may cure or limit the extent of injury inflicted by microorganisms causing the. Identify the components of the history required to rule inout a drug causation. The relationship between proton pump inhibitors and renal disease. Druginduced renal disease diagnostic histopathology. 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. Ppt druginduced kidney disease powerpoint presentation. Prevention, detection, and management is a well organised, easy to use reference source that fills a sizeable gap in the available literature.
Druginduced kidney disease free download as powerpoint presentation. List the drugs most commonly implicated in acute tubular necrosis. Ashp ebooks sign in with your ashp username and password to access purchased ebooks in my library. Pharmaceutical agents provide diagnostic and therapeutic utility that are central to patient care. Drug induced kidney diseases free download as powerpoint presentation. Clinical assessment and management of chronic kidney disease across its stages view more. The kidney maintains the vital functions of clearing excess body fluid and removing metabolic and exogenous toxins from the blood. Druginduced acute kidney injury in children faught 2015. Acute kidney injury acute renal failure explained clearly bun creatinine ratio duration. 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. It is high time to put the global spread of kidney diseases into focus, explain professors david harris and. Hemorrhagic fever with renal syndrome hfrs, hantavirus renal disease, korean hemorrhagic fever, epidemic hemorrhagic fever, nephropathis epidemica hemosiderinuria hemosiderosis related to paroxysmal nocturnal hemoglobinuria and hemolytic anemia.
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. Renal vulnerability to drug toxicity nephrology selfassessment program vol 9, no 4, july 2010 clin j am soc nephrol 4. Drug induced kidney injury is a major side effect in clinical practice, frequently leading to acute renal failure arf. Feb 22, 2016 acute kidney injury acute renal failure explained clearly bun creatinine ratio duration. Identify an approach to incorporating did wi the differential. However, all agents also carry adverse drug effect profiles. Identify risk factors for high probability did causation. Renal phospholipidosis possibly induced by ranolazine. Renal dysfunction and renal disease due to drugs are common and can lead to renal failure, both acute and chronic. Hivassociated nephropathy and druginduced renal injury. The spectrum of infection induced kidney diseases is diverse. Drug induced kidney disease 1 drug induced kidney disease 2 introduction. Patients at highest risk of drug induced nephrotoxicity are those with one or more of the following. The true incidence of druginduced acute and chronic interstitial.
Cellular and molecular pathways of renal repair after acute kidney. Drug induced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. The exact frequency of nephrotoxicity induced by antiviral drugs is difficult to determine. 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. Drugs including antimicrobials, chemotherapeutic agents and non steroidal antiinflammatory drugs nsaids, among others, have all been implicated in drug induced renal injury in children.
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. While most of these are clinically insignificant, some drugs. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain stereotyped renal responses. The pathogenesis of druginduced renal cystic disease.
Medcram medical lectures explained clearly 543,516 views 15. An overview of drug induced acute kidney injury neesh pannu, md, sm, frcp. 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. The pathogenesis of drug induced renal cystic disease. Druginduced acute renal dysfunction karen shalansky, pharm. Guideline on the clinical investigation of medicinal products to. The purpose of this report is to clarify drug induced kidney disease dikd of renal biopsied cases in japan. Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase. Drug induced kidney injury is a frequent adverse event which contributes to morbidity and increased healthcare utilization. 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. Acute renal failure arf is defined as the rapid decline in kidney function as manifested by a reduction in glomerular filtration rate gfr. Druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice.
It gives american society of healthsystem pharmacists 7272 wisconsin avenue bethesda, md 20814 this vital subject the comprehensive coverage that it deserves. Electronic surveillance presents a powerful tool to identify susceptible. The 6rs of drug induced nephrotoxicity bmc nephrology. 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. Listing a study does not mean it has been evaluated by the u.
Its exact incidence is diffi cult to document but about 40,000 to 45,000 people may experience a druginduced liver injury each year. Nephrology journal nephrology and renal diseases journal. This allows the scientific community to view, download, distribution of an article in any medium, provided that the original work is properly cited, under the term of creative commons attribution license. 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. Back to drug induced diseases, 3rd edition protect your patients. Infections manifest in form of several renal clinical syndromes. Antiviral druginduced nephrotoxicity american journal of.
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