Skip to main content

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.


Labels:

Comments

Post a Comment

Popular posts from this blog

Drug-Induced Ototoxicity!

 DRUG-INDUCED OTOTOXICITY What is drug Induced Ototoxicity? Drug-Induced ototoxicity can affect hearing (auditory or cochlear function0, balance (vestibular function) depending on the drug. Drugs of almost every class have been reported to produce tinnitus (sounds in ear), as have placebos. The following agents are associated with measurable changes in hearing or vestibular defect when administered systemically. 1. AMINOGLYCOSIDES: Aminoglycosides antibiotics can cause cochlear or vestibular toxicities. Cochlear toxicity: occurs as progressive hear loss, starting with highest tones and advancing to lower tones. Thus, considerable damage can occur before the patient recognizes it. S ymptoms of Vestibular damage : include;  Dizziness Vertigo Ataxia Both forms of ototoxicity are bilateral and potentially reversible, but permanent damage is common and can progress even after discontinuation of aminoglycosides. Clinically detectable ototoxicity in as many as 5% patients. Most amin...
Post a Comment
Read more

Diabetes Mellitus: Non-Pharmacological Therapy--MNT!

 NON PHARMACOLOGICAL THERAPY  MNT Glycemic Index Dietary supplements Weight measurements Physical Activity Psychological assessment Immunizations 1. MEDICAL NUTRITION THERAPY (MNT)  " Medical Nutrition Therapy (MNT) is a term used by the ADA to describe the optimal condition of caloric intake with other aspects of diabetes therapy (Insulin, Exercise, Weight loss)". The ADA has issued recommendations for three types of MNT: Primary prevention measures of MNT are directed at preventing or delaying the onset of type 2 Diabetes in high-risk individuals (obese or with pre-diabetes) by promoting weight reduction. Secondary prevention measures of MNT are directed at preventing or delaying-related complications in diabetic individuals by improving glycemic control. Tertiary prevention measures of MNT are directed at managing diabetes-related complications (cardiovascular disease, neuropathy) in diabetic individuals. Despite the popular notion, there is not any " Diabetic diet...
Post a Comment
Read more

Medical Emergency- Cardiac Arrest and Basic Life Support (BLS)!

  MEDICAL EMERGENCY- CARDIAC ARREST AND BASIC LIFE SUPPORT Definition: " Cardiac Arrest is a medical emergency requiring a systematic approach". Early recognition must be followed by prompt, effective application of Basic Life Support (BLS) techniques to sustain the patient until Advanced Life Support (ALS) capabilities are available. Management: The management of Cardiac Arrest is a 4-step approach: Recognition and Assessment BLS Advanced Cardiovascular Life Support (ACLS) Post-resuscitation Care 1. RECOGNITION AND ASSESMENT Verify that the respiration and circulation have ceased: Loss of consciousness Loss of functional ventilation (respiratory arrest or inadequate respiratory effort) Loss of functional perfusion (No pulse). 2. BASIC LIFE SUUPORT (BLS) The goal in cardiac arrest is the restoration of spontaneous circulation (ROSC). The first step towards achieving this ROSC goal is prompt initiation of BLS, where the goal is to rapidly and effectively perfuse the tissues wi...
Post a Comment
Read more