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], 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

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

Antivirals

Acyclovir (only nephrotoxic in intravenous form)
Adefovir
Cidofovir
Foscarnet
Indinavir
Tenofovir

Antiparasitic drugs

Chemotherapy and Immunosuppressants

Heavy Metals and Poisons

Arsenic poisoning
Bismuth
Gold therapy
Lead poisoning
Lithium related kidney disorders

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

Gemfibrozil

Associated with acute renal failure due to rhabdomyolysis

Statins

Chemotherapy

Causes fanconi's syndrome

Lomustine

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