Nephrotoxic drugs: Difference between revisions
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==Miscellaneous Drugs== | ==Miscellaneous Drugs== | ||
* Chronic | * Chronic stimulant [[Laxative]] use | ||
:* Resulting chronic volume depletion and [[Hypokalemia]] causes [[nephropathy]] | :* Resulting chronic volume depletion and [[Hypokalemia]] causes [[nephropathy]] | ||
* | * [[Radiocontrast agents]] | ||
* [[ACE Inhibitor]]s | * [[ACE Inhibitor]]s | ||
:* Expect an increase of | :* Expect an increase of [[serum creatinine]] in [[chronic kidney disease]] | ||
* [[ | * [[Allopurinol]] | ||
* [[Aspirin]] | * [[Aspirin]] | ||
:* Low dose [[Aspirin]] reduces [[Renal function]] in elderly | :* Low dose [[Aspirin]] reduces [[Renal function]] in elderly | ||
:*:* Decreased [[Creatinine Clearance]] after 2 weeks of use | :*:* Decreased [[Creatinine Clearance]] after 2 weeks of use | ||
:*:* Changes persisted for at least 3 weeks off [[Aspirin]] | :*:* Changes persisted for at least 3 weeks off [[Aspirin]] | ||
* [[Cimetidine]] | |||
* [[Ciprofloxacin]] | |||
* [[Dilantin]] | |||
* [[Diuretic]]s | |||
:*[[Thiazide]]s | |||
:*[[furosemide]] | |||
* [[Mesalamine]] (Asacol, Pentasa) | * [[Mesalamine]] (Asacol, Pentasa) | ||
:*:* [[Mesalamine]] is an [[NSAID]] analog and has systemic absorption from the bowel | :*:* [[Mesalamine]] is an [[NSAID]] analog and has systemic absorption from the bowel | ||
| Line 71: | Line 77: | ||
:* [[Nephrotic Syndrome]] type reaction | :* [[Nephrotic Syndrome]] type reaction | ||
* [[Rifampin]] | * [[Rifampin]] | ||
==Drugs of abuse== | ==Drugs of abuse== | ||
Revision as of 16:35, 9 August 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Nephrotoxic drugs are pharmacotherapies that can lead to a decline in renal function. The drug may need to be discontinued, or the dosing reduced when this happens.
Antibiotics
- Acyclovir (only nephrotoxic in intravenous form)
- Aminoglycosides (10-15% Incidence of Acute Tubular Necrosis)
- Occurs in 10-20% patients on 7 day course
- Results in non-oligurics; increased Creatinine
- A single dose early in septic course is usually safe
- Amphotericin B (Incidence 80-90%)
- Ciprofloxacin
- Levofloxacin
- Pentamidine
- Rifampin
- Sulfonamides
- Tetracycline
Chemotherapy and Immunosuppressants
Heavy Metals
- Polydipsia and Nephrogenic Diabetes Insipidus
- Acute Renal Failure
- Dialysis indications: Creatinine >2.5 or Seizures, ALOC, Rhabdomyolysis
- Chronic kidney disease with fibrosis
- Mercury Poisoning
AntiHyperlipidemics
- Fenofibrate (Tricor)
- Increases Serum Creatinine without significant decrease in GFR
- Serum Creatinine rise is reversible on stopping Fenofibrate
- Associated with Acute Renal Failure due to Rhabdomyolysis
Chemotherapy
- Causes Fanconi's Syndrome
Miscellaneous Drugs
- Chronic stimulant Laxative use
- Resulting chronic volume depletion and Hypokalemia causes nephropathy
- Expect an increase of serum creatinine in chronic kidney disease
- Low dose Aspirin reduces Renal function in elderly
- Decreased Creatinine Clearance after 2 weeks of use
- Changes persisted for at least 3 weeks off Aspirin
- Low dose Aspirin reduces Renal function in elderly
- Mesalamine (Asacol, Pentasa)
- Mesalamine is an NSAID analog and has systemic absorption from the bowel
- Vasculitis reaction
- Nephrotic Syndrome type reaction