Pdf centers for disease control and prevention 2018. Druginduced renal disease diagnostic histopathology. Druginduced kidney injury is a major side effect in clinical practice, frequently leading to acute renal failure arf. New drugs implicated as the cause of specific disease s. We propose four phenotypes of drug induced kidney disease based on clinical presentation.
Furthermore, the tubulointerstitium is not the only renal compartment involved with this type of injury. Our current knowledge of drug induced kidney disease is limited due to varying definitions of kidney. An overview of drug induced acute kidney injury neesh pannu, md, sm, frcp. Drug induced kidney injury is a major side effect in clinical practice, frequently leading to acute renal failure arf. Chronic kidney disease ckd management in general practice. Patients at highest risk of drug induced nephrotoxicity are those with one or more of the following. Drug induced pseudorenal failure bun due to protein catabolism steroids, tetracyclines scr due to competitive inhibition of creatinine secretion trimethoprim, cimetidine, triamterene with trimethoprim 1535% rise scr fully expressed after 3 days more sig in pts with preexisting renal dysfunction can occur with normal doses completely.
Druginduced impairment of renal function george sunny pazhayattil, anushree c shirali section of nephrology, yale university school of medicine, new haven, ct, usa abstract. Ashp ebooks sign in with your ashp username and password to access purchased ebooks in my library. Dialysis options and pharmacotherapy for endstage renal disease. A new section on drug induced dermatologic diseases. The kidney maintains the vital functions of clearing excess body fluid and removing metabolic and exogenous toxins from the blood. Druginduced kidney disorder disease dkid is an origin of kidney disease followed by acute renal failure. Drug induced kidney diseases np singh, a ganguli, a prakash abstract drug induced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. These factors combine to expose the patient to excess drug concentration and risk of. The clinical manifestations of drug induced renal disease may include all the manifestations attributed to natural or spontaneous renal diseases such as acute renal failure, chronic renal failure, acute nephritic syndrome, renal colic, haematuria, selective tubular defects, obstructive nephropathy, etc. Features and management of druginduced renal failure. Identify the components of the history required to rule inout a drug causation. Munar, pharmd, bcps, and harleen singh, pharmd oregon state university college of pharmacy, portland, oregon. Drug induced kidney disease alwin hl loh and arthur h cohen cellular, tip and collapsing.
Our current knowledge of drug induced kidney disease is limited due to varying definitions of kidney injury, incomplete assessment of concurrent risk factors and lack of long term outcome reporting. Pharmacotherapeutic specialist, vgh clinical professor, ubc apr 8, 2010 outline pseudo renal failure acute renal failure prerenal nsaids, cyatacrolimus, aceiarb, diuretics intrinsic atn vs ain atn aminoglycosides, amphotericin b, radiocontrast media obstructive. Impaired renal function is commonly observed in clinical practice and is often associated with the use of drugs. This is likely related to exposure of these new drugs in patients who have. Patientrelated risk factors druginduced renal disorders are more common in certain patients and in specific clinical situations. Drug dosing adjustments in patients with chronic kidney.
Drugs including antimicrobials, chemotherapeutic agents and nonsteroidal antiinflammatory drugs nsaids, among others, have all been implicated in drug induced renal injury in children. The clinical manifestations of druginduced renal disease may include all the manifestations attributed to natural or spontaneous renal diseases such as acute renal failure, chronic renal failure, acute nephritic syndrome, renal colic, haematuria, selective tubular defects, obstructive nephropathy. Most of these markers deliver information only when renal damage is well. However, all agents also carry adverse drug effect profiles. Drug induced kidney disease 1 drug induced kidney disease 2 introduction. Infants and young children with extracellular volume depletion, sepsis, renal impairment, cardiovascular disease, diabetes, or prior exposure to radio contrast agents are at risk of developing drug nephrotoxicity. You have free access to this content prescriber volume 17, issue 3, article first published online. Rationale and design of the genetic contribution to drug. Identify the laboratory tests required to rule inout as druginduced. Druginduced kidney disease kidney kidney disease free. However, egfr provides a valid estimate of renal drug clearance and is widely. Drugs most often implicated in the development of interstitial nephritis include certain antibiotics, antivirals. Welcome to the fifth edition of the renal drug handbook. The aim of this article is to discuss the pathological features of druginduced renal disease as diagnosed by kidney biopsy.
While overall not well defined in children, the incidence of aki in the paediatric intensive care units is reported to range from 8% to 30% and. Full text druginduced impairment of renal function ijnrd. While most of these are clinically insignificant, some drugs. Renal vulnerability to drug toxicity nephrology selfassessment program vol 9, no 4, july 2010 clin j am soc nephrol 4. Druginduced kidney diseases np singh, a ganguli, a prakash abstract druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. The exact frequency of nephrotoxicity induced by antiviral drugs is difficult to determine. The kidney is particularly vulnerable to drugs and other agents that cause renal damage. Sep 01, 2015 drug induced renal disorders are more common in certain patients and in specific clinical situations. Nephrolithiasis formation of renal calculi or kidney stones occurs as the result of abnormal crystal precipitation in the renal collecting system intratubular precipitation of crystallinematerial prevalence of drug induced nephrolithiasis is 1% signs and symptoms pain, haematuria, infection, or, occasionally, urinary tract obstruction with kidney injury 45. An overview of druginduced acute kidney injury neesh pannu, md, sm, frcp.
If the trial is positive, its findings will potentially translate into safer patient outcomes, by genotypic individualization of therapy and minimization of harm. Interstitial nephritis results from inflammation of the renal interstitium and tubules and can be caused by infections, immunemediated diseases such as sarcoidosis and lymphomas, and drugs. Identify the laboratory tests required to rule inout as drug induced causation. The 6rs of drug induced nephrotoxicity linda awdishu1,2 and ravindra l. Infants and young children with extracellular volume depletion, sepsis, renal impairment, cardiovascular disease, diabetes, or. Combine egfr stage 15, albuminuria stage and underlying diagnosis to.
Markowitz and others were the first to report the association between pamidronate and collapsing glomerulopathy. Druginduced renal toxicity is more common in infants and young children in certain. Pepper professor of public health and preventive medicine professor of biostatistics and epidemiology, medicine, and pharmacology vice dean for institutional affairs university of pennsylvania. Acute kidney injury aki results in the abrupt loss of kidney function. Recognizing risk factors that increase renal vulnerability to druginduced kidney. In addition, drug induced kidney injury, especially of patients in intensive care units. The first one includes stones made of the drug andor its metabolites identified by xray diffraction or infrared spectroscopy on the basis of their specific diagrams.
The inclusion of the levels of evidence classification scheme for identifying drug induced diseases. Overview of druginduced renal impairment in discussing druginduced renal impairment, it is helpful to recall that renal function is a composite of several steps which includes renal arterial blood flow, glomerular filtration, tubular fluid formation, and exit of urine into the urogenital system. Adjustment of several drugs administered to dialysis patients is mandatory because of decreasedand sometimes totally absentrenal clearances. Potential compartments of druginduced renal injury druginduced kidney disease. Druginduced acute kidney injury in children faught. Cite the risk factors for aminoglycoside and radiocontrast induced nephrotoxicity.
The main types of renal injury predominantly involve the tubules and interstitium, leading to acute tubular injury and necrosis, or interstitial nephritis with inflammatory tubular injury. Pharmaceutical agents provide diagnostic and therapeutic utility that are central to patient care. Pdf druginduced kidney disease pathology and current. Drug induced nephrotoxicity tends to occur more frequently in patients. State the drug induced renal structuralfunctional alterations observed, and provide examples of each. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain stereotyped renal responses. C 7, 10, 32, 48 druginduced renal impairment is generally reversible, provided the nephrotoxicity is recognized early and the offending medication is discontinued. The 6rs of drug induced nephrotoxicity bmc nephrology. Describe the pathophysiologic mechanisms of nephrotoxic susceptibility. It manifests as a gradual rise in serum creatinine 4 to 6 weeks after exposure to the drug c. Drugs triamterene, sulfadiazine acetylsulfadiazine crystalluria, indinavir, antiviral drugs. Hepatic failure is a particular risk factor for druginduced renal impairment because cirrhotic patients tend to have reduced muscle mass and hypoalbuminemia, which, as discussed earlier, increases the chance of inadvertent drug overdosing. Druginduced kidney disorderdisease dkid is an origin of kidney disease followed by acute renal failure.
Drug induced kidney disorder disease dkid is an origin of kidney disease followed by acute renal failure. Drug induced kidney disease dikd clinical pharmacy by. It accounts for more than 2% to 15% of cases of arf in patients admitted to the hospital or in the intensive care unit, respectively. Listing a study does not mean it has been evaluated by the u. Antiviral druginduced nephrotoxicity american journal. List the drugs most commonly implicated in acute tubular necrosis. Pepper professor of public health and preventive medicine professor of biostatistics and epidemiology, medicine, and pharmacology vice dean for institutional affairs. List the signs and symptoms that may be present in a patient with druginduced nephrotoxicity din. Perazella, md, facp associate professor of medicine director, renal fellowship program yale university school of medicine. Drug induced kidney disease dikd is a significant contributor of acute kidney injury aki and chronic kidney disease ckd. Druginduced renal disorders are more common in certain patients and in specific clinical situations. Druginduced acute renal dysfunction karen shalansky, pharm. The clinical manifestations of drug induced renal disease may include all the manifestations attributed to natural or spontaneous renal diseases such as acute renal failure, chronic renal failure, acute nephritic syndrome, nephrotic syndrome, renal colic, haematuria, selective tubular defects, obstructive nephropathy, etc. Wanchoo r, thakkar j, schwartz d, jhaveri kd 2016 harvoni ledipasvir with sofosbuvir induced renal injury.
Identify an approach to incorporating did wi the differential. Druginduced encephalopathy secondary to non renal dosing of common medications in two dialysis patients the u. The drug induced renal injury consortium direct the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Estimate renal function, and formulate an appropriate drugdose regimen for a patient with aki not receiving. Patients typically present with nonoliguria, maintaining urine volumes greater than 500 mlday d. Druginduced kidney injury is a significant contributor to the development of aki. Electronic surveillance presents a powerful tool to identify susceptible. Antiviral druginduced nephrotoxicity american journal of. Phenotype standardization for drug induced kidney disease. Biomarkers for druginduced renal damage and nephrotoxicity. Chair and professor, department of biostatistics and epidemiology director, center for clinical epidemiology and biostatistics george s. Renal dysfunction and renal disease due to drugs are common and can lead to renal failure, both acute and chronic. Identify risk factors for high probability did causation. Uppal n, lee tp, shah hh 2016 harvoniassociated acute kidney injury.
Renal biopsy in patients with unexplained renal impairment and normal kidney size. Chronic tubulointerstitial nephritis and nephritis of unknown origin account for 15 to 30 percent of the cases of endstage renal disease esrd in the united states and europe. Druginduced nephrotoxicity is more common in hospitalized patients, in particular. Kidneybased in vitro models for druginduced toxicity testing. Harvoniinduced deterioration of renal and liver function. Druginduced renal disorders journal of renal injury prevention. Overview of drug induced renal impairment in discussing drug induced renal impairment, it is helpful to recall that renal function is a composite of several steps which includes renal arterial blood flow, glomerular filtration, tubular fluid formation, and exit of urine into the urogenital system. The high rate of drug and toxin delivery to the kidney, a result of high renal blood flow, which. It is therefore vital in any patient with renal disease whatever the. Druginduced kidney disease occurs primarily in patients with underlying risk factors.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. Drug dosing adjustments in patients with chronic kidney disease. Renal vulnerability to drug toxicity american society of nephrology. Munar, pharmd, bcps, and harleen singh, pharmd oregon state university college of.
Drug induced impairment of renal function george sunny pazhayattil, anushree c shirali section of nephrology, yale university school of medicine, new haven, ct, usa abstract. Acute kidney injury aki can be described as the sudden decrease in renal function over a variable period of time hours to days and can be caused by numerous aetiologies. Its exact incidence is diffi cult to document but about 40,000 to 45,000 people may experience a druginduced liver injury each year. Druginduced acute kidney injury in children faught 2015. Pdf drug induced acute kidney injury is common in critically ill patients. Patients at highest risk of druginduced nephrotoxicity are those with one or more of the following. Risk factors include prolonged therapy and increased age b. The genetic contribution to drug induced renal injury direct study will be the first observational cohort study to investigate the genetic determinants of dikd. Miller medical 2010 1110 according to the authors, a druginduced disease as an unintended effect of a drug, which results in mortality or morbidity with symptoms sufficient to prompt a patient to seek medical. On completion of this chapter, the student will be able to. Pharmacology behind common drug nephrotoxicities american.
Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes disorders. Drug dosing adjustments in patients with chronic kidney disease myrna y. Drug induced kidney injury is a frequent adverse event which contributes to morbidity and increased healthcare utilization. The kidneys can be damaged by a large number of therapeutic agents. Compare and contrast acute tubular necrosis and acute allergic interstitial nephritis. Druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Wanchoo r, thakkar j, schwartz d, jhaveri kd 2016 harvoni ledipasvir with sofosbuvirinduced renal injury. Mehta2 abstract drug induced kidney injury is a frequent adverse event which contributes to morbidity and increased healthcare utilization. From there, you can view and download your ashp ebooks to the reader of. The clinical manifestations of druginduced renal disease may include all the manifestations attributed to natural or spontaneous renal diseases such as acute renal failure, chronic renal failure, acute nephritic syndrome, nephrotic syndrome, renal colic, haematuria, selective tubular defects, obstructive nephropathy, etc. Nadim, md a cute kidney injury aki is a relatively common condition in the intensive care unit and occurs in 20% to 30% of critically ill patients, with approximately 6% eventually requiring renal replacement therapy 1. Druginduced kidney disease pathology and current concepts. Mar 21, 2007 patients with underlying disease, such as the elderly and those with hypotension and dehydration, are at particular risk for dirf.