Nephrotoxic drugs: Difference between revisions
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==Antibiotics== | ==Antibiotics== | ||
*[[Acyclovir]] (only nephrotoxic in intravenous form) | |||
*[[Aminoglycosides]] (10-15% Incidence of Acute Tubular Necrosis) | *[[Aminoglycosides]] (10-15% Incidence of Acute Tubular Necrosis) | ||
:* Occurs in 10-20% patients on 7 day course | :* Occurs in 10-20% patients on 7 day course | ||
:* Results in non-oligurics; increased [[Creatinine]] | :* Results in non-oligurics; increased [[Creatinine]] | ||
:* A single dose early in septic course is usually safe | :* A single dose early in septic course is usually safe | ||
* [[Amphotericin B]] (Incidence 80-90%) | * [[Amphotericin B]] (Incidence 80-90%) | ||
* [[Ciprofloxacin]] | |||
* [[Levofloxacin]] | * [[Levofloxacin]] | ||
* [[ | * [[Pentamidine]] | ||
* [[Rifampin]] | * [[Rifampin]] | ||
* [[Sulfonamides]] | |||
* [[Tetracycline]] | * [[Tetracycline]] | ||
==Chemotherapy and Immunosuppressants== | ==Chemotherapy and Immunosuppressants== | ||
* [[Cisplatin]] | * [[Cisplatin]] | ||
* [[Cyclosporine]] | |||
* [[Methotrexate]] | * [[Methotrexate]] | ||
* [[Mitomycin]] | * [[Mitomycin]] | ||
== Heavy Metals== | == Heavy Metals== | ||
* [[Arsenic]] Poisoning | |||
* [[Bismuth]] | |||
* [[Mercury]] Poisoning | * [[Mercury]] Poisoning | ||
* [[Lead]] Poisoning | * [[Lead]] Poisoning | ||
* [[Lithium]] related kidney disorders | * [[Lithium]] related kidney disorders | ||
:* [[Polydipsia]] and [[Nephrogenic Diabetes Insipidus]] | :* [[Polydipsia]] and [[Nephrogenic Diabetes Insipidus]] | ||
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==AntiHyperlipidemics== | ==AntiHyperlipidemics== | ||
* [[Fenofibrate]] (Tricor) | * [[Fenofibrate]] (Tricor) | ||
:* Increases Serum [[Creatinine]] without significant decrease in [[GFR]] | :* Increases Serum [[Creatinine]] without significant decrease in [[GFR]] | ||
:* Serum [[Creatinine]] rise is reversible on stopping [[Fenofibrate]] | :* Serum [[Creatinine]] rise is reversible on stopping [[Fenofibrate]] | ||
* [[Gemfibrozil]] | |||
:* Associated with [[Acute Renal Failure]] due to [[Rhabdomyolysis]] | |||
* [[Statin]]s | |||
==Chemotherapy== | ==Chemotherapy== | ||
* [[Cisplatin]] | * [[Cisplatin]] | ||
* | * [[Ifosfamide]] | ||
:* Causes [[Fanconi's Syndrome]] | :* Causes [[Fanconi's Syndrome]] | ||
Revision as of 16:30, 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
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
- Radiographic contrast
- ACE Inhibitors
- 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