Ppt druginduced kidney disease powerpoint presentation. Drug dosing adjustments in patients with chronic kidney disease. Pdf druginduced kidney disease pathology and current. List the drugs most commonly implicated in acute tubular necrosis.
Druginduced liver and kidney injuries are the most common adverse drug reactions in the clinic, and they have similar pathogeneses. The drug may be filtered or secreted into the lumen of the renal tubules. Diagnostics free fulltext acute renal failureacute. State the drug induced renal structuralfunctional alterations observed, and provide examples of each. The type of renal failure is differentiated by the trend in the serum creatinine.
Acute kidney injury is a very common diagnosis, present in up to 60% of critical patients, and its third main cause is drug toxicity. Although currently used liver parameters are sensitive in detecting dili, they are neither specific nor able to predict the patients. File photo by rose lincolnharvard staff photographer. Pdf druginduced kidney disease constitutes an important cause of acute renal failure and chronic kidney disease in present day clinical practice find. Druginduced nephrotoxicity are more common among infants and young children and in certain clinical situations such as underlying renal dysfunction and cardiovascular disease. Druginduced kidney disease pharmacotherapy quick guide.
It depends on filteration active tubular secretionreabsorption passive diffusion. Genetically modified rats, endorgan damage, renal transplantation introduction the prevalence of chronic kidney disease ckd is estimated to be 816% worldwide jha et al. 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. Renal failure in children and elderly persons chronic renal failure in children chronic renal failure in elderly persons r enal failure is a condition in which the kidneys fail to remove metabolic endproducts from the blood and regulate the. Mar 24, 1979 full text full text is available as a scanned copy of the original print version. We analyzed the data of 26,535 cases that were registered in the. Drug induced kidney disease is associated with increases in mortality, length of stay, and healthcare costresources. The kidney maintains the vital functions of clearing excess body fluid and removing metabolic and exogenous toxins from the blood. Although each one of these drug categories can lead to renal failure, they are not, by themselves, as dangerous as when the three of them.
Drug induced kidney disease dikd clinical pharmacy by. Get a printable copy pdf file of the complete article 617k, or click on a page image below to browse page by page. Drug induced liver injury is a cause of acute and chronic liver disease the liver plays a central role in transforming and clearing chemicals and is susceptible to the toxicity from these agents. The kidneys can be damaged by a large number of therapeutic agents. We analyzed the data of 26,535 cases that were registered in. Early detection of drugs adverse effects is important to prevent progression to endstage renal disease. 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. Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase and fluid electrolytes disorders. Patients at highest risk of druginduced nephrotoxicity are those with one or more of the following. Decreased urination, hypervolemia edema, n, loss of appetite, malaise, confusion, scr may lag behind renal damage by 12 days preventing di aki avoid nephrotoxic drugs in patients with risk factors for aki.
Renal dysfunction and renal disease due to drugs are common and can lead to renal failure, both acute and chronic. 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. Druginduced colitis encompasses a wide spectrum of colon disorders that can manifest microscopically or macroscopically. Differentiate druginduced liver disease from other causes of liver pathology, using knowledge of liver function tests and other signs and symptoms. The purpose of this report is to clarify drug induced kidney disease dikd of renal biopsied cases in japan. Pharmacologic agents responsible for inducing this entity include antibiotics, diuretics, and nonsteroidal antiinflammatory drugs. Handbook of drug therapy in liver and kidney disease annals. Researchers find drug that could halt kidney failure.
Drug dosing adjustments in patients with chronic kidney disease myrna y. Druginduced renal disease, like other iatrogenic disorders, bedevils the patient and humbles the physician. Drug induced renal disease is common and responsible for a variety of pathological effects on the kidney, many of which are potentially recoverable. Druginduced kidney disease free download as powerpoint presentation. Druginduced kidney disorderdisease dkid is an origin of kidney disease followed by acute renal failure.
Druginduced renal disease is common and responsible for a variety of pathological effects on the kidney, many of which are potentially recoverable. Rationale and design of the genetic contribution to drug. Hivassociated nephropathy and druginduced renal injury. The lengthy appended table provides data on percent oral availability, percent protein binding, volume of distribution, metabolism and elimination, normal halftime, anephric halftime, hepatic disease halftime, dose changes at three levels of renal. Chronic kidney disease clinical features and renal. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Munar, pharmd, bcps, and harleen singh, pharmd oregon state university college of pharmacy, portland, oregon. 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. Monitoring for druginduced liver disease must be tailored to the drug and the patients potential risk factors. In a case of undiagnosed renal disease a possibility of drug induced renal failure should be kept as the prompt removal of the drug and supportive management can reverse the renal dysfunction to a.
Cite the risk factors for aminoglycoside and radiocontrast induced nephrotoxicity. Contrast induced nephropathy cin is still poorly defined and due a wide range of confounding individual variables, its risk is difficult to determine. With an aging population, and rising levels of hypertension, diabetes and obesity, renal diseases pose an increasing burden on public healthcare. If the drug is primarily cleared by the kidney, the drug will become increasingly concentrated as it is moves from the renal artery into the smaller vasculature of the kidney. 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. 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. Renal function and proteinuria improved after the drug was discontinued and steroid therapy begun. Drugs can cause acute renal injury, intrarenal obstruction, interstitial nephritis, nephrotic syndrome, and acidbase. The purpose of this report is to clarify druginduced kidney disease dikd of renal biopsied cases in japan.
Nov 21, 2015 the japan renal biopsy registry jrbr was started in 2007 by the committee for the standardization of renal pathological diagnosis and the committee for the kidney disease registry of the japanese society of nephrology. Harvard researchers have found that the use of a rheumatoid arthritis drug has saved transplanted kidneys in four patients and achieved disease remission in a fifth. Druginduced nephrotoxicity is a common problem in clinical medicine and the incidence of drugrelated acute kidney injury aki may be as. Diseases and conditions that may slow blood flow to the kidneys and lead to kidney injury include. Druginduced kidney diseasealwin hl loh and arthur h cohen druginduced kidney disease pathology and current concepts alwin hl loh,1mbchbhons, frcpath, arthur h cohen,2,3md introduction departing from the usual account of druginduced renal disease according to the specific type of drug, we divide. Electronic surveillance presents a powerful tool to identify susceptible. A, b, and c are good, moderate, and poor evidence to support recommendation, respectively. The drug induced renal injury consortium full text view. Compared with 30 years ago, the average patient today is older, has more comorbidities.
An overview of druginduced acute kidney injury neesh pannu, md, sm, frcp. We recently examined five patients with glomerular disease and druginduced. It is therefore vital in any patient with renal disease whatever the. Renal manifestations of druginduced systemic lupus. Listing a study does not mean it has been evaluated by the u. Druginduced interstitial nephritis is being recognized with increasing frequency. Druginduced stones represent about 1% of all renal stones. Drug induced kidney disease dikd is a significant contributor of acute kidney injury aki and chronic kidney disease ckd.
Interpret the findings for potential druginduced renal damage, complications from chronic diseases such as hypertension and diabetes mellitus and the presence or absence of other common renal. Drug induced renal disease identifying drug induced aki drug induced to be shorted to di sx. What drug is known to cause renal tubular obstruction. The genetic contribution to drug induced renal injury direct study will be the first observational cohort study to investigate the genetic determinants of dikd. Druginduced kidney disease annals academy of medicine. Idiosyncratic druginduced liver injury idili is a rare but potentially severe adverse drug reaction that should be considered in patients who develop laboratory criteria for liver injury secondary to the administration of a potentially hepatotoxic drug. Drug induced kidney disease 1 drug induced kidney disease 2 introduction. Patients at highest risk of drug induced nephrotoxicity are those with one or more of the following. Hepatotoxicity from hepatic toxicity implies chemicaldriven liver damage. Acyclovirinduced renal failure in an obese patient.
Chair and professor, department of biostatistics and epidemiology director, center for clinical epidemiology and biostatistics george s. Druginduced renal toxicity is more common in infants and young children in certain. 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. To analyze the clinical characteristics of patients with druginduced liver andor kidney injury. Acute kidney failure symptoms and causes mayo clinic. Identification of patients in the early stages of the disease allows steps to be taken that slow progression to renal failure requiring dialysis or transplantation chronic kidney disease clinical features and renal replacement therapies reena popatis senior renal pharmacist at barts and. 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 kidney is particularly vulnerable to drugs and other agents that cause renal damage. Perazella, md, facp associate professor of medicine director, renal fellowship program yale university school of medicine. Renal disease induced by drugs was studied by percutaneous biopsy in 40 patients.
An overview of drug induced acute kidney injury neesh pannu, md, sm, frcp. Nsaidcoxib induced hemodynamic renal failure nsaids causes hemodynamic acute renal failure due to inhibition of the synthesis of vasodilatory prostaglandins which are mainly contributing the vasodilation of afferent arterioles for normal maintenance of gfr cox2 inhibitors celecoxib and. Full text druginduced impairment of renal function ijnrd. Chronic kidney disease is a growing health problem. 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. Sep 01, 2015 drug induced renal disorders are more common in certain patients and in specific clinical situations. The drug induced renal injury consortium direct the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Drug induced kidney diseases authorstream presentation.
Nonsteroidal antiinflammatory drug induced acute kidney. Drugs of mw feb 22, 2016 drug induced kidney diseases scientific team. Drug dosing adjustments in patients with chronic kidney. 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. List drugs that are known to cause nephrolithiasis. Druginduced kidney disease pathology and current concepts. Renal failure secondary to crescentic glomerulonephritis developed in a patient who had typical serologic features of drug induced systemic lupus erythematosus after two years of therapy with procainamide. Use of aspirin, ibuprofen advil, motrin ib, others, naproxen sodium aleve, others or related drugs. Druginduced nephrotoxicity american family physician. The true incidence of druginduced acute and chronic interstitial nephritis is probably. Jul 15, 2009 a case of acyclovir induced acute renal failure in an obese patient is described. Different classes of drugs, by virtue of immunological mechanisms or direct toxicity initiate certain stereotyped renal responses. Druginduced renal disease diagnostic histopathology.
If the trial is positive, its findings will potentially translate into safer patient outcomes, by genotypic individualization of therapy and minimization of harm. We know now that the dose of tdf needs to be adjusted in patients with preexisting renal disease. The number of drugs associated with adverse reactions involving the liver is extensive, but in clinical practice is dominated by alcohol, antibiotics, and acetaminophen. 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. Drug induced kidney injury is a frequent adverse event which contributes to morbidity and increased healthcare utilization.
Cin mainly affects patients with underlying chronic kidney disease, diabetes, sepsis, heart failure, acute coronary syndrome and cardiogenic shock. Drug induced renal disease, like other iatrogenic disorders, bedevils the patient and humbles the physician when he finds that he has done harm at the time he thought he was doing good. The incidence of drug induced nephrotoxicity is 1426% in adults and 16% in paediatric cases 1. Compare and contrast acute tubular necrosis and acute allergic interstitial nephritis. The aim of this article is to discuss the pathological features of drug induced renal disease as diagnosed by kidney biopsy. The initial diagnosis of druginduced kidney disease dikd typically involves detection of elevated serum creatinine scr and blood urea nitrogen, for which.
Pepper professor of public health and preventive medicine professor of biostatistics and epidemiology, medicine, and pharmacology vice dean for institutional affairs university of pennsylvania. Liver and renal disease patient assessment in pharmacy. The japan renal biopsy registry jrbr was started in 2007 by the committee for the standardization of renal pathological diagnosis and the committee for the kidney disease registry of the japanese society of nephrology. Druginduced renal disorders journal of renal injury prevention. The 6rs of drug induced nephrotoxicity bmc nephrology.
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