Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes disorders. The purpose of this report is to clarify druginduced kidney disease dikd of renal biopsied cases in japan. Druginduced nephrotoxicity is a common problem in clinical medicine and the incidence of drugrelated acute kidney injury aki may be as high. Druginduced renal disorders journal of renal injury prevention. 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. 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. List of fda orphan drugs gard has information from the food and drug administration fda on treatments approved for rare diseases, known as orphan productsdrugs. 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. Druginduced thrombocytopenia is the most common druginduced hematologic disorders, with some reports suggesting that as many as 5% of patients who receive heparin develop heparininduced thrombocytopenia. Diagnosis, management and prevention of druginduced liver injury. 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 into the urogenital system.
Druginduced kidney disease kidney kidney disease free. Druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. We analyzed the data of 26,535 cases that were registered in the. Druginduced kidney disease pathology and current concepts. 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 toxininduced liver injury chapter 10. Compare and contrast acute tubular necrosis and acute allergic interstitial nephritis. Diagnosis of drug induced 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 drug related signature. A thorough physical examination and medical history should be performed. 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. The 6rs of drug induced nephrotoxicity bmc nephrology. Nov 21, 2015 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. Renal vulnerability to drug toxicity nephrology selfassessment program vol 9, no 4, july 2010 clin j am soc nephrol 4. Chair and professor, department of biostatistics and epidemiology director, center for clinical epidemiology and biostatistics george s.
Furthermore, the tubulointerstitium is not the only renal compartment involved with this type of injury. Data were collected through a survey of patient file records. An overview of drug induced acute kidney injury neesh pannu, md, sm, frcp. The true incidence of druginduced acute and chronic interstitial nephritis is probably underestimated as interstitial nephritis is a nonspecific finding in chronically scarred kidneys.
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 occur with normal doses completely. 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. The kidney maintains the vital functions of clearing excess body fluid and removing metabolic and exogenous toxins from the blood. Cite the risk factors for aminoglycoside and radiocontrast induced nephrotoxicity. Drug induced kidney injury is a frequent adverse event which contributes to morbidity and increased healthcare utilization. Drug induced thrombocytopenia is the most common drug induced hematologic disorders, with some reports suggesting that as many as 5% of patients who receive heparin develop heparin induced thrombocytopenia. Druginduced renal disease, like other iatrogenic disorders, bedevils the patient and humbles the physician.
Druginduced renal disease can mimic renal disease from other causes, such as autoimmune disease and infection. Patient specific disease specific age older than 60 years diabetes genetic variation in cyp3a4, mdr1, ace, tgf. List of fda orphan drugs genetic and rare diseases. Full text druginduced impairment of renal function ijnrd. Ppt druginduced kidney disease powerpoint presentation. State the drug induced renal structuralfunctional alterations observed, and provide examples of each. Dili and apap 2014 identifying druginduced hepatotoxicity is vital bad outcomes can and do occur. List the drugs most commonly implicated in acute tubular necrosis. 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. The initial diagnosis of druginduced 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. Nephrotoxicity can be defined as any renal injury caused directly or indirectly by medications, with acute renal failure, tubulopathies, and. Drug induced kidney disease free download as powerpoint presentation. Identify an approach to incorporating did wi the differential. Druginduced kidney disease 1 druginduced kidney disease 2 introduction.
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. Tuberculosis in southern african hiv clinicians society. Interval between drug withdrawal and onset of steriod. 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. Although medications are a widely known cause of tubulointerstitial damage, drug related glomerular. Mechanisms of druginduced acute and chronic renal damage. Frequent psych issues and drug abuse in both groups multiple products important in at least 20%, more in pain patients. Druginduced nephrotoxicity are more common among infants and young children and. 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. Identify risk factors for high probability did causation. 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. Druginduced nephrotoxicity is a common problem in clinical medicine and the incidence of drugrelated acute kidney injury aki may be as high as 60 percent 14. 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.
Multiple logistic regression interval longer than 7 days between drug withdrawal and onset of steroid treatment or 6. 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. Identify the components of the history required to rule inout a drug causation. The condition can be costly and may require multiple interventions, including hospitalization. Electronic surveillance presents a powerful tool to identify susceptible. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain stereotyped renal responses. Acute kidney injury aki may occur 3 to 16 months after cpi exposure, which makes extended renal function monitoring critical for detection and treatment. Pdf druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying. Druginduced kidney disease free download as powerpoint presentation. Drugs can cause acute renal injury, intra renal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes disorders.
However, when exposure to these drugs cannot be avoided, recognition of risk factors and specific techniques, such as. Sep 01, 2015 drug induced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Pepper professor of public health and preventive medicine professor of biostatistics and epidemiology, medicine, and pharmacology vice dean for institutional affairs university of pennsylvania. Drug induced kidney disease can occur due to patient related factors and in specific disease table 1. Drugs triamterene, sulfadiazine acetylsulfadiazine crystalluria, indinavir, antiviral drugs. The orphan drug act was passed in 1983 to give drug companies incentives to develop treatments for rare diseases. Endstage renal disease druginduced renal mass 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. May 10, 2010 drug induced kidney injury is a serious and not uncommon adverse event in drug development. The true incidence of drug induced acute and chronic interstitial nephritis is probably underestimated as interstitial nephritis is a nonspecific finding in chronically scarred kidneys.
Drug induced kidney disease 1 drug induced kidney disease 2 introduction. Drugs known to be nephrotoxic include several cancer therapeutics. Management of drug induced liver injury is symptomatic, with early referral to a liver transplant unit at the first hint of liver. 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. Renal injury is common in apap still the largest cause of death from alf in us overall summary. A number of new peripheral biomarkers have been proposed to detect renal injury earlier than the current. Patients at highest risk of drug induced nephrotoxicity are those with one or more of the following. The purpose of this report is to clarify drug induced kidney disease dikd of renal biopsied cases in japan. Medcram medical lectures explained clearly 543,516 views 15. 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. We analyzed the data of 26,535 cases that were registered in. Perazella abstract drugs and toxins frequently are associated with the development of various types of acute kidney disease and ckd.
Renal dysfunction and renal disease due to drugs are common and can lead to renal failure, both acute and chronic. Any stimuli that induce loss of these cells can induce kidney damage. Chronic drug induced renal damage o cyclosporine o aristolochic acid nephropathy o warfarin o takaout. 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. The kidney is particularly vulnerable to drugs and other agents that cause renal damage. 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 tract obstruction with kidney injury 45. Nonsteroidal antiinflammatory drug induced acute kidney. Druginduced kidney disease is best prevented by avoiding the use of potentially nephrotoxic agents for patients at increased risk for toxicity.
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