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

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

PNEUMONIA- Its Etiology, Pathophysiology, Classification and Severity Assessment Method!

 PNEUMONIA Definition: "Pneumonia is an infection of pulmonary parenchyma". (Harrison)                                                    OR "Pneumonia is defined as an acute respiratory illness associated with recently developed radiological pulmonary shadowing which may be segmental, lobar or multilobar". (Davidson) Etiology: Microorganisms gain excess to the lower respiratory tract in several ways: Aspiration from the oropharynx (most common). Inhalation of contaminated droplets. Hematogenous spread. Contiguous extension. Pathophysiology of Pneumonia: Pneumonia results from proliferation of microbial pathogens at the alveolar level and the hosts response to these microorganisms.  Defensive Mechanisms against Pneumonia: The defensive mechanism against pneumonia involve: Branching architecture of tracheobronchial tree. Muco-ciliary clearance. Local...
Post a Comment
Read more

Anatomy and the Complications Associated with Liver Diseases!

  LIVER AND THE COMPLICATIONS ASSOCIATED WITH THE PROGRESSION OF DISEASE! Liver: The liver weighs up to 1.5kg in adults and is the 2nd largest organ in the body. Hepatocytes are the functioning unit of liver. Impairment of liver may lead to: Acute liver diseases Chronic liver diseases Liver cirrhosis Acute Liver Disease (ALD): ALD is a self-limiting episode of hepatocyte damage which in most cases spontaneously without clinical sequelae, but acute liver failure (ALF) may develop. This is a rare condition in which there is a rapid deterioration in liver function with associated encephalopathy and coagulopathy. ALF carries significant morbidity and mortality and may require emergency liver transplant. Chronic Liver Disease (CLD): CLD occurs when the longstanding cell damage causes permanent structural changes within the liver, with the loss of normal liver structure and functions. In many cases, this may lead to cirrhosis where fibrosis sears divide the liver cells into areas of rege...
Post a Comment
Read more