Use analgesics with less prostaglandin activity (acetaminophen, aspirin, sulindac, nabumetone )Ĭorrect volume depletion before initiation of drug, especially if used on a chronic basis Underlying renal insufficiency intravascular volume depletion age older than 60 years concomitant use of ACE inhibitors, ARBs, NSAIDs, cyclosporine (Neoral), or tacrolimus (Prograf) Lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix)ĭrugs altering intraglomerular hemodynamics 10 – 12, 23, 32 Pathophysiologic mechanism of renal injuryĪcute interstitial nephritis, altered intraglomerular hemodynamics, chronic interstitial nephritis, glomerulonephritisĪmitriptyline (Elavil*), doxepin (Zonalon), fluoxetine (Prozac)Ĭhronic interstitial nephritis, glomerulonephritis, rhabdomyolysisĭiphenhydramine (Benadryl), doxylamine (Unisom)Īcute interstitial nephritis, crystal nephropathyĪmphotericin B (Fungizone* deoxycholic acid formulation more so than the lipid formulation)īeta lactams (penicillins, cephalosporins)Īcute interstitial nephritis, glomerulonephritis (ampicillin, penicillin)Ĭrystal nephropathy, tubular cell toxicityĪcute interstitial nephritis, crystal nephropathy (ciprofloxacin )Īdefovir (Hepsera), cidofovir (Vistide), tenofovir (Viread)Īltered intraglomerular hemodynamics, chronic interstitial nephritis, thrombotic microangiopathyĪngiotensin-converting enzyme inhibitors, angiotensin receptor blockersĬlopidogrel (Plavix), ticlopidine (Ticlid)Ĭarmustine (Gliadel), semustine (investigational)Ĭhronic interstitial nephritis, tubular cell toxicityĬocaine, heroin, ketamine (Ketalar), methadone, methamphetamine ![]() General preventive measures include using alternative non-nephrotoxic drugs whenever possible correcting risk factors, if possible assessing baseline renal function before initiation of therapy, followed by adjusting the dosage monitoring renal function and vital signs during therapy and avoiding nephrotoxic drug combinations. Some patient-related risk factors for drug-induced nephrotoxicity are age older than 60 years, underlying renal insufficiency (e.g., glomerular filtration rate of less than 60 mL per minute per 1.73 m 2), volume depletion, diabetes, heart failure, and sepsis. Therefore, successful prevention requires knowledge of pathogenic mechanisms of renal injury, patient-related risk factors, drug-related risk factors, and preemptive measures, coupled with vigilance and early intervention. Drug-induced nephrotoxicity tends to be more common among certain patients and in specific clinical situations. Drugs shown to cause nephrotoxicity exert their toxic effects by one or more common pathogenic mechanisms. Compared with 30 years ago, the average patient today is older, has more comorbidities, and is exposed to more diagnostic and therapeutic procedures with the potential to harm kidney function. ![]() ![]() Drugs are a common source of acute kidney injury.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |