Infants and young children with extracellular volume depletion, sepsis, renal impairment, cardiovascular disease, diabetes, or. Drug induced renal disease is common and responsible for a variety of pathological effects on the kidney, many of which are potentially recoverable. These factors combine to expose the patient to excess drug concentration and risk of. In addition, druginduced kidney injury, especially of patients in intensive care units. Despite best efforts to assure that all drugs are safe and effective, millions of patients each year develop druginduced diseases. 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. The risk of contrastinduced nephropathy is highest in diabetics and chronic kidney disease diabetes 9. Overview of druginduced renal impairment in discussing druginduced 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. The exact frequency of nephrotoxicity induced by antiviral drugs is difficult to determine. Druginduced impairment of renal function george sunny pazhayattil, anushree c shirali section of nephrology, yale university school of medicine, new haven, ct, usa abstract. Full text druginduced impairment of renal function ijnrd. Drug induced kidney disease can occur due to patient related factors and in specific disease table 1.
Since the first edition of this book was published in 2005, numerous drugs have been withdrawn from the market in the united states as a result of morbidity andor mortality associated with drug induced diseases. What are the mechanisms of renal ischemia with iv dye induced neprotoxicity. Chair and professor, department of biostatistics and epidemiology director, center for clinical epidemiology and biostatistics george s. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain stereotyped renal responses. What does chronic onset tubulointerstitial diseases involve. Acute kidney injury aki is a serious problem occurring in anywhere between 8 and 30% of children in the intensive care unit. Pepper professor of public health and preventive medicine professor of biostatistics and epidemiology, medicine, and pharmacology vice dean for institutional affairs university of pennsylvania. Management of druginduced liver injury is symptomatic, with early referral to a liver transplant unit at the first hint of liver. Druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Biomarkers for druginduced renal damage and nephrotoxicity.
Drug induced liver injury is among the most challenging disorders for gastroenterologists to diagnose and treat, but the american college of gastroenterology has issued new clinical guidelines to. 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. Consensus document on the management of renal disease in hiv. 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. Pages in category drug induced diseases the following 16 pages are in this category, out of 16 total.
The drug induced renal injury consortium full text view. Drug induced kidney injury is a major side effect in clinical practice, frequently leading to acute renal failure arf. Drug induced diseases also called as iatrogenic diseases, are well known but least studied entity. Clinical pharmacology for the nephrologist khaled eldahshan, md lecturer of nephrology, mansoura urology and nephrology center. Estimate renal function, and formulate an appropriate drugdose regimen for a patient with aki not receiving rrt. Patient specific disease specific age older than 60 years diabetes genetic variation in cyp3a4, mdr1, ace, tgf. 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.
Drug induced kidney injury is a frequent adverse event which contributes to morbidity and increased healthcare utilization. Druginduced kidney diseasealwin hl loh and arthur h cohen druginduced kidney disease pathology and current concepts alwin hl loh,1mbchbhons, frcpath, arthur h cohen,2,3md introduction departing from the usual account of druginduced renal disease according to the specific type of drug, we divide. Pharmaceutical agents provide diagnostic and therapeutic utility that are central to patient care. Most of these markers deliver information only when renal damage is well. Druginduced liver injury is among the most challenging disorders for gastroenterologists to diagnose and treat, but the american college of gastroenterology has. Druginduced kidney disease pathology and current concepts. Clinical pharmacology for the nephrologist khaled eldahshan, md lecturer of nephrology, mansoura urology and nephrology center, mansoura university introduction pharmacokinetics iatrogenic renal diseases. The clinical manifestations of druginduced 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. Mar 21, 2007 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. Perazella, md, facp associate professor of medicine director, renal fellowship program yale university school of medicine. Diagnosis of druginduced liver diseases can be difficult, but the key to causality is to diligently exclude other causes of liver injury, and to identify a characteristic clinical drugrelated signature. Drug induced acute renal dysfunction karen shalansky, pharm. Druginduced acute kidney injury in children faught. Harvoni induced deterioration of renal and liver function.
The renal proximal tubule is a main target for druginduced toxicity. From there, you can view and download your ashp ebooks to the reader of your choice. The drug induced renal injury consortium direct the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Since the publication of the first edition of this book in 2005, numerous drugs have been withdrawn from the market in the united states because of morbidity andor mortality associated with druginduced disease. Harvoniinduced deterioration of renal and liver function. Our patient had multiple comorbidities including ckd and compensated cirrhosis of liver. Drug interactions between antiretroviral drugs and immunosuppressants. The prediction of proximal tubular toxicity during drug development remains difficult. Despite best efforts to assure that all drugs are safe and effective, millions of patients each year develop drug induced diseases.
Hivassociated nephropathy and druginduced renal injury. Druginduced acute renal dysfunction karen shalansky, pharm. Compare and contrast acute tubular necrosis and acute allergic interstitial nephritis. 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. Nephrotoxicity has a wide spectrum, reflecting damage to different nephron segments based upon individual drug mechanisms. The aim of this article is to discuss the pathological features of drug induced renal disease as diagnosed by kidney biopsy. Pharmacotherapeutic specialist, vgh clinical professor, ubc apr 8, 2010 outline pseudo renal failure acute renal failure. 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. Mar 29, 2005 drug induced kidney injury is a major side effect in clinical practice, frequently leading to acute renal failure arf. It is therefore vital in any patient with renal disease whatever the. 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. Pdf one of the most important drugrelated problems in patients with chronic kidney disease ckd is medication dosing errors. 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 is thought to occur in.
Renal insufficiency and intravascular volume depletion increase the risk of crystal nephropathy. Sign in with your ashp username and password to access purchased ebooks in my library. Prediction of druginduced nephrotoxicity and injury. Druginduced kidney disease free download as powerpoint presentation.
Pdf drug induced acute kidney injury is common in critically ill patients. Miller medical 2010 1110 according to the authors, a druginduced disease as an unintended effect of a drug, which results in mortality or morbidity with symptoms sufficient to prompt a patient to seek medical attention andor require. Listing a study does not mean it has been evaluated by the u. Feb 22, 2016 acute kidney injury acute renal failure explained clearly bun creatinine ratio duration. Renal biopsy in patients with unexplained renal impairment and normal kidney size. These defects combine with lowered hdlc levels low apoa1 and ii to generate a highly. Druginduced encephalopathy secondary to non renal dosing of common medications in two dialysis patients the u. The national kidney disease education program of the national institute of diabetes and. 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.
Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase. Renal disease induced by drugs 112 have increased in geometrical progression over the last 20 years. Concentration of the drug in the urine and urinary. Patients at highest risk of drug induced nephrotoxicity are those with one or more of the following. 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. Renal dysfunction and renal disease due to drugs are common and can lead to renal failure, both acute and chronic.
Druginduced encephalopathy secondary to non renal dosing. Antiviral druginduced nephrotoxicity american journal of. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Kidneybased in vitro models for druginduced toxicity testing.
However, all agents also carry adverse drug effect profiles. The incidence of arf, although relatively common, is difficult to define, and the incidence of druginduced renal failure dirf is even more difficult to ascertain. Understanding the mechanism of drug induced renal damage helps to decide. Its exact incidence is diffi cult to document but about 40,000 to 45,000 people may experience a druginduced liver injury each year. Personal contribution springerlink skip to main content. Comorbid conditions such as liver disease, heart disease, and ckd. Druginduced kidney diseasepathology and current concepts. 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 constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. If the drug is primarily cleared by the kidney, the drug will become increasingly concentrated as it is moves from the renal artery into the smaller vasculature of the kidney.
Druginduced acute kidney injury in children faught 2015. An overview of druginduced acute kidney injury neesh pannu, md, sm, frcp. Chronic kidney disease ckd american society of nephrology. Dec 12, 2014 overview of drug induced renal impairment. Aminoglycoside antibiotics, nonsteroidal antiinflammatory drugs nsaids, contrast agents, and angiotensin converting enzyme inhibitors aceis are the most common cause of aki in hospitalized patients 2. Antiviral druginduced nephrotoxicity american journal. Up to 25% of these cases are believed to be the result of pharmacotherapy. Druginduced kidney injury is a major side effect in clinical practice, frequently leading to acute renal failure arf. Druginduced nephrotoxicity is increasingly recognized as a significant contributor to kidney disease including acute kidney injury aki and chronic kidney disease ckd. Patients at highest risk of druginduced nephrotoxicity are those with one or more of the following. Drug dosing adjustments in patients with chronic kidney. Any drug in the blood will eventually reach the highly vascularized kidneys. Despite best efforts to ensure the safety and effectiveness of all drugs, millions of patients each year develop druginduced diseases.
Drug dosing adjustments in patients with chronic kidney disease myrna y. These factors combine to increase patient exposure to excess drug concentrations and nephrotoxicity risk. Druginduced liver injury guidelines released by acg. Drug induced kidney disease dikd clinical pharmacy by. 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.
It gives american society of healthsystem pharmacists 7272 wisconsin avenue bethesda, md 20814 this vital subject the comprehensive coverage that it deserves. The 6rs of drug induced nephrotoxicity bmc nephrology. Nsaidcoxib induced hemodynamic renal failure nsaids causes hemodynamic acute renal failure due to inhibition of the synthesis of vasodilatory prostaglandins which are mainly contributing the vasodilation of afferent arterioles for normal maintenance of gfr cox2 inhibitors celecoxib and. Druginduced renal disease diagnostic histopathology. Drug induced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. Adjustment of several drugs administered to dialysis patients is mandatory because of decreasedand sometimes totally absentrenal clearances. Sep 01, 2015 drug induced renal disorders are more common in certain patients and in specific clinical situations. List the drugs most commonly implicated in acute tubular necrosis.
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. Since the first edition of this book was published in 2005, numerous drugs have been withdrawn from the market in the united states as a result of morbidity andor mortality associated with druginduced diseases. Druginduced encephalopathy secondary to non renal dosing of. 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. Druginduced kidney diseases np singh, a ganguli, a prakash abstract druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. Phenotype standardization for drug induced kidney disease. Pharmacology behind common drug nephrotoxicities american. Most are hyperosmotic, leading to osmotic diuresis and dehydration. Patientrelated risk factors druginduced renal disorders are more common in certain patients and in specific clinical situations. 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. The pathogenesis of druginduced renal cystic disease.
Medcram medical lectures explained clearly 543,516 views. Renal vulnerability to drug toxicity american society of nephrology. Diagnosis, management and prevention of druginduced liver. Cite the risk factors for aminoglycoside and radiocontrast induced nephrotoxicity.