Effects of Drugs on the Human Kidneys ( nephrotoxicity)

Nephrotoxicity - a poisonous effect of some substances, both toxic chemicals and medications on the kidney


This is not to be confused with the fact that some medications have a predominantly renal excretion and need their dose adjusted for decreased renal function. An example of this is Heparin.


Heparin:

A sulphur-containing polysaccharide, it is used as an anticoagulant in the treatment of thrombosis. Used on patients who are suffering from kidney failure.

Drugs cause approximately 20 percent of community-and hospital-acquired episodes of acute renal failure. Drugs are a common source of acute kidney injury. Compared with 30 years ago, the average patient today is older.

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), volume depletion, diabetes, heart failure, and sepsis.

Among older adults, the incidence of drug-induced nephrotoxicity may be as high as 66 percent. Compared with 30 years ago, patients today are older, have a higher rate of diabetes and cardiovascular disease, take multiple medications, and are exposed to more diagnostic and therapeutic procedures with the potential to harm kidney function. Although renal impairment is often reversible if the offending drug is discontinued, the condition can be costly and may require multiple interventions, including hospitalization.

Drugs Associated with Nephrotoxicity

Drug class/drug(s)
Pathophysiologic mechanism of renal injury

Analgesics

Acetaminophen, aspirin
Chronic interstitial nephritis

Nonsteroidal anti-inflammatory drugs
Acute interstitial nephritis, altered intraglomerular hemodynamics, chronic interstitial nephritis, glomerulonephritis

Antidepressants/mood stabilizers

Amitriptyline (Elavil*), doxepin (Zonalon), fluoxetine (Prozac)
Rhabdomyolysis

Lithium
Chronic interstitial nephritis, glomerulonephritis, rhabdomyolysis

Antihistamines

Diphenhydramine (Benadryl), doxylamine (Unisom)
Rhabdomyolysis

Antiretrovirals

Adefovir (Hepsera), cidofovir (Vistide), tenofovir (Viread)
Tubular cell toxicity

Indinavir (Crixivan)
Acute interstitial nephritis, crystal nephropathy

Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers
Altered intraglomerular hemodynamics

Clopidogrel (Plavix), ticlopidine (Ticlid)
Thrombotic microangiopathy

Statins
Rhabdomyolysis

Chemotherapeutics

Carmustine (Gliadel), semustine (investigational)
Chronic interstitial nephritis

Cisplatin (Platinol)
Chronic interstitial nephritis, tubular cell toxicity

Interferon-alfa (Intron A)
Glomerulonephritis

Mitomycin-C (Mutamycin)
Thrombotic microangiopathy

Contrast dye
Tubular cell toxicity

Diuretics

Loops, thiazides
Acute interstitial nephritis

Triamterene (Dyrenium)
Crystal nephropathy

Drugs of abuse

Cocaine, heroin, ketamine (Ketalar), methadone, methamphetamine
Rhabdomyolysis