The definition of acute kidney injury has changed in recent years, and detection is now mostly based on monitoring creatinine levels, with or without urine output. Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes disorders. Hivassociated nephropathy and druginduced renal injury. Druginduced kidney disease kidney kidney disease free.
Cisplatininduced acute tubular injury and necrosis. Acute kidney injury aki independently increases morbidity and mortality in children admitted to the hospital. Exercise induced acute renal failure without rhabdomyolysis is not a rare condition. Management of acute renal failure eddie needham, m. Full text druginduced impairment of renal function ijnrd. Exerciseinduced acute renal failure without rhabdomyolysis is not a rare condition. Pdf druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice find. Anemia is uncommon in animals with acute renal failure unless there is volume overload, in which case the protein will also be decreased.
It develops slowly, usually over the course of a number of years. Acute renal failure arf is defined as a rapid loss of renal function due to damage to the kidneys. The decision to initiate rrt is complex and often complicated by concerns related to patient hemodynamic and thermodynamic instability. Kidney failure also called renal failure is a term used to describe when a persons kidneys stop working properly, or fail. A 27 year old female was seen by medical personnel at an after hours clinic. The main drug classes linked to ain are antibiotics, ppis, and nonsteroid antiinflammatory drugs. Druginduced nephrotoxicity is a common problem in clinical medicine and the incidence of drugrelated acute kidney injury aki may be as high as 60 percent 14. Acute renal failure is often a complication of the following. Certain drugs can cause alteration in intraglomerular hemodynamics, inflammatory changes in renal tubular cells, leading to acute kidney injury aki.
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. Exerciseinduced acute kidney injury in a police officer with. Renal vulnerability to drug toxicity nephrology selfassessment program vol 9, no 4, july 2010 clin j am soc nephrol 4. Chronic renal failure develops slowly, and there are not many noticeable symptoms at first chronic renal failure can be a sign of other diseases. They include sepsis, paracentesis induced hypovolaemia, alcoholic cardiomyopathy or any combination of these iii prevention and treatment.
Patient specific disease specific age older than 60 years diabetes genetic variation in cyp3a4, mdr1, ace, tgf. Acute kidney failure is most common in people who are already hospitalized, particularly in critically ill people who need intensive care. Causes of acute renal failure article pdf available in compendium on continuing education for the practising veterinarian north american edition 285. Data sources include ibm watson micromedex updated 4 may 2020, cerner multum updated 4 may 2020. The patient should be weighed at leastonce daily, and input and output should be monitored strictly, with clinical status assessed constantly. 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. We experienced 6 cases 5 men and a woman during last the 8 years. Table 1 renal complications of nonsteroidal antiinflammatory drug use. Mar 21, 2007 the incidence of arf, although relatively common, is difficult to define, and the incidence of drug induced renal failure dirf is even more difficult to ascertain.
Drug induced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. Current information suggests that arf accounts for 1% of hospital admissions, implicating occurrence in the outpatient setting, and occurs in 2% to 5% of inhospital patients. Mechanisms of druginduced acute and chronic renal damage. Nsaids can reduce renal blood flow, cause tubular obstruction through crystal deposition, and induce direct cytotoxicity and cellmediated immune injury mechanisms leading to the occurrence of acute kidney injury aki. Druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice. Case report enalapril induced reversible acute renal failure. You have free access to this content prescriber volume 17, issue 3, article first published online. Nonsteroidal antiinflammatory drug induced acute kidney. Conventionally, the causes of arf are classified by renal anatomy into pre renal, renal and post renal. Physical examination showed the patient had some edema. While in most cases, the druginduced kidney injury is reversible upon cease of treatment some medications could lead to chronic dysfunction.
Tubular injury is often accompanied by increased fractional excretion of sodium fe na. Group kdigo kakiw 2012 kdigo clinical practice guideline for acute kidney injury. Exerciseinduced acute renal failure associated with. Conventionally, the causes of arf are classified by renal anatomy into prerenal, renal and postrenal. The treatment options are dialysis or a kidney transplant. This results in electrolyte and acidbase abnormalities and retention of nitrogenous waste products, such as urea and creatinine. Features and management of druginduced renal failure. The prognosis of acute renal failure remains poor and mortality ranged from 40% to 80%. Exerciseinduced acute renal failure associated with renal. Patients at highest risk of drug induced nephrotoxicity are those with one or more of the following. Renal disease 1 acute renal failure learning article. Exerciseacute kidney injuryhereditary renal hypouricemiapolice. The condition can be costly and may require multiple interventions, including hospitalization.
Thirtyone different drugs produced the following clinical entities. This article provides a summary of the most common mechanisms of druginduced nephrotoxicity and prevention strategies. Mar 24, 2020 other examination methods for acute renal failure imaging techniques can also provide useful additional information or a differential diagnosis. Druginduced nephrotoxicity is a common problem in clinical medicine and the incidence of drugrelated acute kidney injury aki may be as. All cases complained of severe loin pain and nausea after mild to moderate exercises for example, a track race in an athletic meeting. Physiopathologic effects include hemodynamic alterations, failure in the synthesis of glomerular matrix, degradation and oxidative stress and induced renal atherogenesis. Focus on diagnosing and treaang acute renal disease okso it is aki acute kidney injury and nor arf. Celecoxib and rofecoxib were documented to cause acute renal failure arf and hyperkalemia in 3 patients.
Enalapril induced reversible acute renal failure detected by 99mtcdmsa renal scan in a patient with bilateral renal artery stenosis. Acute renal failure goals all of these are real cases from u of i. However, the above studies suggest that tdf may be. Case report enalapril induced reversible acute renal. The incidence of arf, although relatively common, is difficult to define, and the incidence of druginduced renal failure dirf is even more difficult to ascertain. Acute renal failure is abrupt in onset and often is reversible if recognized early and treated appropriately.
Druginduced acute renal dysfunction karen shalansky, pharm. E renal injury due to environmental toxins, drugs, and contrast agents. Acute kidney injury jordan university of science and technology. Acute renal failure arf, acute kidney failure online. Nonsteroidal antiinflammatory drug induced acute kidney injury in. Druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease.
Phenotypr standardization for drug induced kidney disease. Acute kidney injury jordan university of science and. 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. Kidneybased in vitro models for druginduced toxicity testing. Renal injury caused by medication can usually be reversed if detected early. Patients with hereditary renal hypouricemia have a higher risk. Maryann kelly is an assistant professor of anesthesiology and assistant director of the graduate program in nurse anesthesia at baylor college of medicine, houston, tx. This term was adopted because the condition is understood to be a continuum of injury, rather than a discrete episode of organ failure defined by arbitrary values. Palmer bf 2002 renal dysfunction complicating the treatment of hypertension. Jul 12, 20 acute renal failure dr cherelle fitzclarence may 2010. Medicationinduced renal failure is a commonly seen problem, especially in the. Drugs can cause acute renal injury, intra renal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes disorders. Druginduced acute renal dysfunction acute renal failure. Another symptom that is commonly caused by nsaids is.
Drugassociated renal dysfunction and injury nature. Acute renal failure dr cherelle fitzclarence may 2010. Medication induced renal failure is a commonly seen problem, especially in the. Renal replacement therapy rrt is an essential therapy in the setting of aki and fluid overload. 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. The chronic renal failure was likely degenerative due to his age, and the acute failure due to his new medications. Acute kidney injury, previously known as acute renal failure, encompasses a wide spectrum of injury to the kidneys, not just kidney failure. Acute renal failure is common in hospitalized patients and occurs in approximately 20% of patients admitted to the intensive care unit. Acute kidney injury aki may occur 3 to 16 months after cpi exposure, which makes extended renal function monitoring critical for detection and treatment.
It is also being increasingly recognised that even small impairments to renal function. The authors and the publisher have exerted every effort to. 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. Name 4 biochemistry parameters that will be increased in a patient with acute renal failure. The relationship between proton pump inhibitors and renal disease. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain stereotyped renal responses. Most etiologies of aki can be prevented by interventions at the individual, community, regional and inhospital levels. Acute renal failure and other complications induced by. Acute renal failure acute renal failure represents a rapid decline in renal. Druginduced renal damage can be acute or chronic, prerenal, intrarenal vascular, tubular, glomerular or interstitial. Nsaids can result in a variety of renal complications table 1.
Acute renal failure is a syndrome characterized by a sudden decrease of the. It has a high index of mortality and its mechanisms remain unknown. Background nonsteroidal antiinflammatory drugs nsaids are a common cause of adverse drug events ades, but renal risks of nsaids are less well quantified than gastrointestinal and cardiac risks. The cost of one survivor leaving icu with renal failure is 70 times that of a patient without renal impairment. Druginduced kidney disease free download as powerpoint presentation. However, this is an oversimplification, since many cases have a mixture of pre, post and renal components. Acute kidney failure can be fatal and requires intensive treatment.
Pdf nonsteroidal antiinflammatory drug induced acute. Acute kidney injury is the new consensus term that replaces the term acute renal failure. Sep 01, 2015 drug induced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Nephrotoxic agents have been implicated as etiologic. Renal dysfunction and renal disease due to drugs are common and can lead to renal failure, both acute and chronic. Sonography can be used to detect enlarged kidneys and confirm a diagnosis of arf. The worldwide incidence of renal side effects is reported to be around 1%5%.
They include sepsis, paracentesisinduced hypovolaemia, alcoholic cardiomyopathy or any combination of these iii prevention and treatment. However, it may be more useful from a clinical point of view to classify drug induced renal toxicity into four major renal syndromes. Nephrotoxicity results in serious clinical syndromes, including acute kidney injury aki. Nonsteroidal antiinflammatory drug induced acute kidney injury in the community.
In contrast, chronic renal failure is the end result of irreparable damage to the kidneys. Certain drugs can cause alteration in intraglomerular hemodynamics, inflammatory changes in renal tubular cells, leading to acute kidney injury. No matter which treatment you choose, youll need to make some changes in your life, including how you eat and plan your activities. If your kidneys fail, you need treatment to replace the work they normally do. Drug induced toxic acute tubular necrosis atn patients with toxic atn present with acute renal failure that may be olguric andor require dialysis. The term aki has replaced acute renal failure because smaller changes in kidney function without overt fail. An overview of druginduced acute kidney injury neesh pannu, md, sm, frcp.
Drug induced kidney disease can occur due to patient related factors and in specific disease table 1. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Nephrotoxic acute renal failure arf is a major cause of arf in hospitalized patients, accounting for 2030% of arf episodes 1, 3. Acute renal failure arf, characterized by sudden loss of the ability of the kidneys to excrete wastes, concentrate urine, conserve electrolytes, and maintain fluid balance, is a frequent clinical problem, particularly in the intensive care unit, where it is associated with a mortality of between 50% and 80%. Chronic heart failure hf improving outcomes and preventing admissions may 2009 produced by rxfiles a provincial academic detailing service funded by saskatchewan health. Acute kidney failure also called acute renal failure or acute kidney injury develops rapidly, usually in less than a few days. Other examination methods for acute renal failure imaging techniques can also provide useful additional information or a differential diagnosis.
235 775 1562 661 964 820 467 634 1412 1265 644 1265 96 107 74 42 1369 1135 49 50 173 122 264 955 1211 610 1272 68 1253 75 587 1206 363 528 363 93