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Drug-Induced Nephrotoxicity!

 DRUG-INDUCED NEPHROTOXICITY

  • Drug-Induced Nephrotoxicity is increasingly recognized as a significant contributor to kidney disease including Acute Kidney Injury (KI) and chronic kidney disease (CKD).
  • Nephrotoxicity has a wide spectrum, reflecting damage to different nephron segments based upon individual drug-mechanisms.


1. ACE-INHIBITORS:

  • ACE-Inhibitors are frequently associated with Proteinuria and Renal Insufficiency.
  • The prevalence of Proteinuria in Captopril treated patient is estimated to be 1%.
  • The risk of Renal Insufficiency is greater with long-acting ACE Inhibitors such as Lisinopril or Enalapril than with Captopril.
  • Immune complex glomerulopathy is a major contribute to ACE Inhibitor nephrotoxicity.
  • Predisposing factors include:

  1. Hyponatremia
  2. Diuretic therapy
  3. Pre-existing renal impairment
  4. Congestive Heart Failure (CHF)
  5. Diabetes Mellitus

  • Recovery of renal function usually follows ACE-Inhibitor discontinuation.


2. CEPHLOSPORIN:

  • The cephalosporin antibiotics are capable of producing rare Interstitial Nephritis similar to Penicillin's.
  • Increase in BUN and Cr(s) occur occasionally.
  • Nephrotoxicity of newer drugs is minimal compared with older such as Cephalothin.


3. DIURETICS(THIAZIDE):

  • Occasional cases of Interstitial Nephritis have been reported, which might be the result of hypersensitivity reaction.
  • Lomg-term use of diuretics increases the risk of Renal cell carcinoma, especially in women.


4. NSAIDs:

  • NSAIDs including COX-2 Inhibitors can reduce Cr (Cl) and produce renal insufficiency as a result of renal circulatory changes caused by inhibition of PG synthesis. These effects are usually reversible.
  • The prevalence is usually 1%.
  • Predisposing factors include:

  1. Old age
  2. Preexisting renal impairment
  3. Hypotension
  4. CHF
  5. Hepatic cirrhosis

  • Fenoprofen is the NSAID most commonly associated with interstitial nephritis and nephrotic syndrome.


5. OMEPRAZOLE:

  • Interstitial nephritis occurs rarely during omeprazole therapy.
  • At least 13 cases were published; 10 with positive biopsies; 5 cases were rechallenged with recurrence of interstitial nephritis in all.
  • Onset is usually after 2 weeks to 6 months of Omeprazole therapy.


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