Drug induced renal disease pdf

Phenotype standardization for druginduced kidney disease. The causative drug must be identified and its use must be. In the former ain has changed since the time when methicillininduced case, the ain is associated with a glomerulonephritis and. Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes. The kidney is particularly vulnerable to drugs and other agents that cause renal damage. Druginduced acute kidney injury in children faught 2015. Drug induced renal disease identifying drug induced aki drug induced to be shorted to di sx. The aim of this article is to discuss the pathological features of druginduced renal disease as diagnosed by kidney biopsy. Drug induced kidney injury is a frequent adverse event which contributes to morbidity and increased healthcare utilization. Pdf acute renal failure in patients with chronic kidney. Acute kidney injury aki can be described as the sudden decrease in renal function over a variable period of time hours to days and can be caused by numerous aetiologies. Pepper professor of public health and preventive medicine professor of biostatistics and epidemiology, medicine, and pharmacology vice dean for institutional affairs university of pennsylvania.

Druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. Dec 20, 2017 druginduced calculi represent 12% of all renal calculi. Direct glomerular cell injury involving the mesangial, endothelial, and visceral epithelial cells is an important form of druginduced disease. Chronic kidney disease ckd patients are at a high risk for acute renal failure. 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. Druginduced kidney disease kidney kidney disease free. In comparison, aki induced by the cancer chemotherapeutic and. Drugs including antimicrobials, chemotherapeutic agents and nonsteroidal antiinflammatory drugs nsaids, among others, have all been implicated in drug induced renal injury in children. Nonsteroidal antiinflammatory drug induced acute kidney. Oral ulcers, hair loss, photosensitivity and central nervous system symptoms are also very rare in drug induced lupus.

Druginduced kidney stones and crystalline nephropathy. Drug induced lupus and sle sle is distinct from drug induced lupus, since dil generally has milder symptoms than sle, and no skin or kidney disease. Since it is virtually impossible to distinguish an iatrogenic drug induced pl from fabrys disease on ultrastructural analysis of kidney tissue, the clinician has to use the patients family history, extra renal symptoms, and biochemical features, such as a reduced. Unfortunately, drugs remain a relatively common cause of acute and chronic kidney injury. The kidneys can be damaged by a large number of therapeutic agents. A combination of factors including the innate nephrotoxicity of drugs, underlying patient characteristics that increase their risk for kidney injury, and the metabolism and pathway of excretion by the kidneys of the various. Druginduced renal disease is common and responsible for a variety of pathological effects on the kidney, many of which are potentially recoverable. These drugs need to be identified and avoided to prevent kidney injury. As more investigators have taken advantage of relatively new methods to isolate pure nonparenchymal cells, there have been rapid gains in information on the contribution of kupffer cells, sinusoidal endothelial cells, and stellate cells to a variety of liver diseases, including drug and toxin induced liver injury chapter 10.

Milionis and moses s elisaf, journalamerican journal of kidney diseases. Druginduced renal disorders are more common in certain patients and in specific clinical situations. 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. In some cases, this condition can progress to endstage kidney failure. The purpose of this report is to clarify drug induced kidney disease dikd of renal biopsied cases in japan. The incidence of drug induced nephrotoxicity is 1426% in adults and 16% in paediatric cases 1. Renal dysfunction can be categorised as prerenal uraemia, intrinsic damage or postrenal uraemia according to the underlying pathophysiological process. The potential of medications to cause kidney injury is well known. Druginduced renal impairment involves many classes of drugs and includes. Finally, metaanalyses, studies with drug induced renal structuralfunctional alterations observed, and provide examples of each. Nephrotoxicity is an inherent adverse effect of certain anticancer drugs. Druginduced kidney diseasealwin hl loh and arthur h cohen cellular, tip and collapsing. 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.

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. Druginduced acute renal dysfunction karen shalansky, pharm. Electronic surveillance presents a powerful tool to identify susceptible. The kidney maintains the vital functions of clearing excess body fluid and removing metabolic and exogenous toxins from the blood. 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. The pathogenesis of drug induced renal cystic disease. Pharmaceutical agents provide diagnostic and therapeutic utility that are central to patient care. Correction of hypovolaemia and hypotension restores baseline renal. Druginduced nephrotoxicity is increasingly recognized as a significant contributor to kidney disease including acute kidney injury aki and chronic kidney disease ckd. While most of these are clinically insignificant, some drugs. Drug dosage adjustment for patients with acute or chronic kidney disease is an accepted standard of practice.

Ppt druginduced kidney disease powerpoint presentation. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain. Druginduced acute kidney injury in children faught. In this setting, some of the lesions described include nodular glomerulosclerosis from smoking, thrombotic microangiopathy tma from numerous medications, minimal change disease mcd, and fsgs. Drug induced kidney disease dikd clinical pharmacy by. 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. Drug induced nephrotoxicity is caused by nephrotoxic drugs or toxins which damage kidneys and can lead to nephritis or renal toxicity. It is therefore vital in any patient with renal disease whatever the. Kidney disease and failure are so hard to detect, in fact, that its possible to lose up to 90% of kidney function without experiencing any symptoms or problems, according to webmd. Renal dysfunction and renal disease due to drugs are common and can lead to renal failure, both acute and chronic. Druginduced kidney disease pathology and current concepts. Self assessment quiz drug induced renal disease see related pages 1.

Oral administration of 2amino4,5diphenyl thiazole hci to rats over a period of 11 weeks produced marked, diffuse, progressive renal cystic disease without significant tubular obstruction or interstitial fibrosis. Druginduced renal disorders journal of renal injury prevention. Drug induced kidney disease is a frequent cause of renal dysfunction. Druginduced renal disorders journal of renal injury. Druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. The first one includes poorly soluble drugs with high urine excretion that favour crystallisation in the urine. Drug induced nephrotoxicity is caused by nephrotoxic drugs that cause kidney damage.

Development of hemodynamically mediated renal failure. The initial diagnosis of drug induced kidney disease dikd typically involves detection of elevated serum creatinine s cr and blood urea nitrogen, for which there is a temporal relationship between the toxicity and use of a potentially nephrotoxic drug drug induced kidney disease is best prevented by avoiding the use of potentially nephrotoxic agents. Ag induced acute renal failure is generally nonoliguric, and may be associated with decreasedurineconcentratingabilityand urinary magnesium wasting. 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. An overview of drug induced acute kidney injury neesh pannu, md, sm, frcp. The 6rs of drug induced nephrotoxicity bmc nephrology. Druginduced renal disease identifying druginduced aki drug induced to be shorted to di sx. Drug induced nephrotoxicity tends to occur more frequently in patients. The pathogenesis of druginduced renal cystic disease. Full text druginduced impairment of renal function ijnrd. Certain clinical and laboratory features may distinguish these.

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. Knotek druginduced kidney injury severe and hemodialysis is frequently needed to treat renal failure and decrease drug burden. Pdf druginduced kidney disease pathology and current. 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. Druginduced renal disease, like other iatrogenic disorders, bedevils the patient and humbles the physician when he finds that he has done harm at the time he thought he was doing good. Druginduced renal disease can mimic renal disease from other causes, such as autoimmune disease and infection. Druginduced renal impairment is generally reversible, provided the nephrotoxicity is recognized early and the offending medication is. Although nephrotoxicity is most commonly associated with injury in the tubulointerstitial compartment as either acute tubular necrosis or acute interstitial nephritis, a growing body of literature has also highlighted the potential for drug induced glomerular lesions. The mechanisms mediating renal cell death induced by nephrotoxicants and renal pathologies are strikingly similar. Drug induced renal disease, like other iatrogenic disorders, bedevils the patient and humbles the physician when he finds that he has done harm at the time he thought he was doing good. Certain drugs can cause alteration in intraglomerular. Nonsteroidal antiinflammatory drugs nsaids are a common cause of adverse drug events ades, but renal risks of nsaids are less well quantified than gastrointestinal and cardiac risks. Finally, longterm abuse of analgesics including nsaids might play a part in the pathophysiology of analgesic induced nephropathy 17, 18.

Renal complications of nonsteroidal antiinflammatory drugs. Markowitz and others were the first to report the association between pamidronate and collapsing glomerulopathy. Intrinsic renal damage results from prolonged hypoperfusion, exposure to. The drugs reported to produce calculi may be divided into two groups. The general population is exposed to a variety of potential nephrotoxic substances including prescribed therapeutic agents, overthecounter products, diagnostic agents, and environmental substances. Rapid development of druginduced lupus nephritis in the. Nephrotoxicity has a wide spectrum, reflecting damage to different nephron segments based upon individual drug mechanisms. However, when exposure to these drugs cannot be avoided, recognition of risk factors and specific techniques, such as hydration, may be used to reduce potential nephrotoxicity. Chair and professor, department of biostatistics and epidemiology director, center for clinical epidemiology and biostatistics george s. Cite the risk factors for aminoglycoside and radiocontrast induced nephrotoxicity.

Sep 01, 2015 drug induced renal disorders are more common in certain patients and in specific clinical situations. 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. Drug induced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Drug induced kidney disease 1 drug induced kidney disease 2 introduction. Drug induced autoimmune disease was initially described decades ago, with reports of vasculitis and a lupuslike syndrome in patients taking hydralazine, procainamide, and sulfadiazine. For example, ischemia induced aki involves atp depletion, oxidative stress, proximal tubule cell death and loss of the brush border membrane, and cell polarity devarajan, 2006. C 7, 10, 32, 48 druginduced renal impairment is generally reversible, provided the nephrotoxicity is recognized early and the offending medication is discontinued. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain stereotyped renal responses.

We convened a panel of international, adult and pediatric, nephrologists and pharmacists to develop standardized phenotypes for drug induced kidney disease as part of the phenotype standardization project. 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. Clinical evidence of ag induced acute tubular necrosis is seen within 5 to 10 days of initiation of ag treatment. Decreased urination, hypervolemia edema, n, loss of appetite, malaise, confusion, scr may lag behind renal damage by 12 days preventing di aki avoid nephrotoxic drugs in patients with risk factors for aki. Drugs are one of the most common causes of kidney damage. Aminoglycosides amg and contrast agents are the major culprit drugs contributory amg are prototype drugs having nephrotoxicity as major to kidney damage. Renal phospholipidosis possibly induced by ranolazine. However, all agents also carry adverse drug effect profiles. Hall 1 from the 1 swiss national centre of competence in research nccr kidney control of homeostasis, institute of anatomy, university of zurich, zurich, switzerland, 2 ucl centre for nephrology, royal free hospital, london, uk and 3 department of cellular pathology, royal free hospital, london, uk.

Druginduced renal disease current diagnostic pathology. Patients at highest risk of drug induced 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 constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. We convened a panel of international, adult and pediatric, nephrologists and pharmacists. Drug induced kidney disease free download as powerpoint presentation. Anticancer druginduced kidney disorders springerlink. List the drugs most commonly implicated in acute tubular necrosis. Renal disease induced by drugs was studied by percutaneous biopsy in 40 patients. The challenge is how to accurately estimate a patients kidney function in both acute and chronic kidney disease and determine the influence of renal replacement therapies on drug disposition. Drug induced kidney disease dikd is a significant contributor of acute kidney injury aki and chronic kidney disease ckd. Compare and contrast acute tubular necrosis and acute allergic interstitial nephritis. Druginduced renal disease diagnostic histopathology. Acute kidney injury aki may occur 3 to 16 months after cpi exposure, which makes extended renal function monitoring critical for detection and treatment.

While overall not well defined in children, the incidence of aki in the paediatric intensive care units is reported to range from 8% to 30% and. Glomerular filtration rate must be estimated in all patients with hypertension, diabetes and other ckd risk factors for diagnosis and staging of ckd. Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes disorders. A thorough physical examination and medical history should be performed. Drug induced pseudo renal 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. Drug induced kidney disease is best prevented by avoiding the use of potentially nephrotoxic agents for patients at increased risk for toxicity. The initial step in the development of kidney injury involves exposure to a potentially toxic offending agent. Mar 21, 2007 patients with underlying disease, such as the elderly and those with hypotension and dehydration, are at particular risk for dirf. 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. Always look for reversible causes in patients presenting with renal failure. Over the years, multiple other agents have been linked to immunemediated glomerular disease, often with associated autoantibody formation.

Drug induced renal disease is common and responsible for a variety of pathological effects on the kidney, many of which are potentially recoverable. Pharmacology behind common drug nephrotoxicities american. Druginduced kidney disease 1 druginduced kidney disease 2 introduction. For most patients suffering from druginduced nephropathy common risk factors which precipitate the adverse effects include. Number of patients developing nephrotoxicity accounted for 20% of all arf in an indian study. Druginduced nephrotoxicity american family physician. Druginduced renal disease, like other iatrogenic disorders, bedevils the patient and humbles the physician. Hivassociated nephropathy hivan is a kidney disease often seen in intravenous drug users afflicted by hiv 2.