Nephrotoxic drugs: Difference between revisions
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==Antibiotics== | ==Antibiotics== | ||
===Antibacterials=== | ===Antibacterials=== | ||
*[[Aminoglycosides]] (10-15% Incidence of | *[[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]] | ||
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== Heavy Metals and Poisons== | == Heavy Metals and Poisons== | ||
*[[Arsenic]] | *[[Arsenic]] poisoning | ||
*[[Bismuth]] | *[[Bismuth]] | ||
*Gold therapy | *Gold therapy | ||
*[[Lead]] | *[[Lead]] poisoning | ||
*[[Lithium]] related kidney disorders | *[[Lithium]] related kidney disorders | ||
:*[[Polydipsia]] and [[ | :*[[Polydipsia]] and [[nephrogenic diabetes insipidus]] | ||
:*[[Acute | :*[[Acute renal failure]] | ||
:*:*[[Dialysis]] indications: [[Creatinine]] >2.5 or [[ | :*:*[[Dialysis]] indications: [[Creatinine]] >2.5 or [[seizure]]s, [[rhabdomyolysis]] | ||
:*[[Chronic kidney disease]] with [[fibrosis]] | :*[[Chronic kidney disease]] with [[fibrosis]] | ||
*[[Mercury]] Poisoning | *[[Mercury]] Poisoning | ||
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*[[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 [[ | :*[[Serum creatinine]] rise is reversible on stopping [[fenofibrate]] | ||
*[[Gemfibrozil]] | *[[Gemfibrozil]] | ||
:*Associated with [[ | :*Associated with [[acute renal failure]] due to [[rhabdomyolysis]] | ||
*[[Statin]]s | *[[Statin]]s | ||
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*[[Cisplatin]] | *[[Cisplatin]] | ||
*[[Ifosfamide]] | *[[Ifosfamide]] | ||
:* Causes [[ | :* Causes [[fanconi's syndrome]] | ||
*[[Lomustine]] | *[[Lomustine]] | ||
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==Miscellaneous Drugs== | ==Miscellaneous Drugs== | ||
* Chronic stimulant [[ | * Chronic stimulant [[laxative]] use | ||
:* Resulting chronic volume depletion and [[hypokalemia]] causes [[nephropathy]] | :* Resulting chronic volume depletion and [[hypokalemia]] causes [[nephropathy]] | ||
* [[Radiocontrast agents]] | * [[Radiocontrast agents]] | ||
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*[[Allopurinol]] | *[[Allopurinol]] | ||
*[[Aspirin]] | *[[Aspirin]] | ||
:* Low dose [[ | :* Low dose [[aspirin]] reduces [[renal function]] in elderly | ||
:*:* Decreased [[ | :*:* Decreased [[creatinine clearance]] after 2 weeks of use | ||
:*:* Changes persisted for at least 3 weeks off [[ | :*:* Changes persisted for at least 3 weeks off [[aspirin]] | ||
*Aristocholic acid containing Chinese herbals | *Aristocholic acid containing Chinese herbals | ||
*[[Bevacizumab]] | *[[Bevacizumab]] | ||
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*[[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 | ||
*[[NSAID]]s: [[ | *[[NSAID]]s: [[celecoxib]], [[ibuprofen]], [[naproxen]] | ||
:*[[Nephrotic | :*[[Nephrotic syndrome]] type reaction | ||
*[[Penicillin]]s and [[ | *[[Penicillin]]s and [[cephalosporin]]s | ||
*[[Pamidronate]] | *[[Pamidronate]] | ||
*[[Propylthiouracil]] | *[[Propylthiouracil]] | ||
Revision as of 14:37, 10 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], Aarti Narayan, M.B.B.S [3]
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.
Common Nephrotoxic drugs
- Acetaminophen
- Aspirin
- H1 antagonist
- Cephalosporins
- Cocaine
- Diuretics
- NSAIDs
- Penicillins
- Proton pump inhibitors
- Angiotensin converting enzyme inhibitors
- Statins
Antibiotics
Antibacterials
- 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
- Chloroquine
- Erythromycin
- Gentamycin
- Hydroxychloroquine
- Isoniazide
- Levofloxacin
- Methicillin
- Rifampin
- Sulfonamides
- Tetracycline
- Trimethadione
- Vancomycin
Antivirals
Antiparasitic drugs
Chemotherapy and Immunosuppressants
Heavy Metals and Poisons
- Polydipsia and nephrogenic diabetes insipidus
- Acute renal failure
- Dialysis indications: Creatinine >2.5 or seizures, rhabdomyolysis
- Chronic kidney disease with fibrosis
- Mercury Poisoning
- Nitrosourea compounds
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
Proton channel blockers
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
- Aristocholic acid containing Chinese herbals
- Bevacizumab
- Carbon tetrachloride
- Cimetidine
- Ciprofloxacin
- Clopidogrel
- Dilantin
- Diuretics
- Infliximab
- Interferons
- Mesalamine (Asacol, Pentasa)
- Mesalamine is an NSAID analog and has systemic absorption from the bowel
- Nephrotic syndrome type reaction
- Vasculitis reaction