Nephrotoxic drugs

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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

• Cisplatin
• Cyclosporine
• Methotrexate
• Mitomycin

Heavy Metals

• Arsenic Poisoning
• Bismuth
• Lead Poisoning
• Lithium related kidney disorders

• 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

• Gemfibrozil

• Associated with Acute Renal Failure due to Rhabdomyolysis

• Statins

Chemotherapy

• Cisplatin
• Ifosfamide

• 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

• NSAIDs
• Aspirin

• 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

• Mesalamine (Asacol, Pentasa)

• • Mesalamine is an NSAID analog and has systemic absorption from the bowel

• Penicillins and Cephalosporins

• Hypersensitivity (fever, rash, arthralgia)

• Sulfonamides

• Vasculitis reaction

• NSAIDs

• Nephrotic Syndrome type reaction

• Rifampin
• Diuretics (Thiazides and furosemide)
• Allopurinol
• Cimetidine
• Ciprofloxacin
• Dilantin

Drugs of abuse

• Cocaine

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