More Related Content
Similar to Drug induced kidney disease (20)
More from swathisravani (20)
Drug induced kidney disease
- 1. Drug induced kidney disease Dr. V. S. Swathi Assistant Professor 1
- 2. Definition It is defined as abrupt or gradual loss of renal function due to drugs and is characterised by increased serum creatinine value and blood urea nitrogen which is having temporal relationship between renal toxicity and drug 2
- 3. Epidemiology • Acute tubular necrosis is most common cause of drug induced kidney disease in hospitalised patients • Mostly this problem is reversible with discontinuation of offending agent but sometimes it is irreversible even after withdrawl of drug • In adults, it is approximately 14-26% in prospective studies of acute kidney injury • In paediatric population, it is responsible for 16% of drug induced Acute kidney injury which leads to hospitalisation • In India, it leads to 20% of total acute kidney injury cases 3
- 4. Risk factors • Increased age • Alcohol abuse • Pre existing kidney disease • Critically ill patients • Large total cumulative dose of drugs • Prolonged therapy of nephrotoxic drugs • Concomitant therapy of 2 or more nephrotoxic drugs • Diabetes • Poor nutrition • Shock • Liver diseases • Dehydration • Hypotension • Cardiovascular diseases • Administration of contrast media 4
- 5. Causes Tubular epithelial cell damage • Acute tubular necrosis • Aminoglycosides • Amphotericin B • Antiviral drugs • Anticancer drugs • Radiographic contrast media Osmotic nephrosis • Mannitol • Sucrose • IV immunoglobulin 5
- 6. Causes continued…. Hemodynamically mediated kidney injury • Angiotensin converting enzyme inhibitors • Angiotensin receptor blockers • Non steroidal anti inflammatory drugs 6
- 7. Causes continued…. Obstructive nephropathy Crystal nephropathy • Anti viral drugs • Sulphonamides • Methotrexate Nephrolithiasis • Sulphonamides Nephrocalcinosis • Oral sodium phosphate solution 7
- 8. Causes continued…. Glomerular disease Minimal change disease • Non steroidal anti inflammatory drugs • Lithium Focal segmental Glomerulosclerosis • Interferon alpha and beta • Anabolic steroids Membranous disease • Non steroidal anti inflammatory drugs • Captopril 8
- 9. Causes continued…. Tubulointerstitial disease Acute allergic interstitial nephritis • Pencillins • Ciprofloxacin • Non steroidal anti inflammatory drugs • Proton pump inhibitors • Loop diuretics Chronic interstitial nephritis • Lithium • Cyclosporine Papillary necrosis • Non steroidal anti inflammatory drugs • Aspirin • Caffeine 9
- 10. Causes continued…. Renal Vasculitis, thrombosis and cholesterol emboli Vasculitis and Thrombosis • Allopurinol • Propylthiouracil Cholesterol emboli • Warfarin • Thrombolytic agents 10
- 11. Pathogenesis 11
- 17. 17
- 18. 18
- 19. Clinical presentation • Decrease in glomerular filtration rate • Increase in serum creatinine and blood urea nitrogen • Malaise • Anorexia • Vomiting • Oedema • Shortness of breath • Decreased urine output • Metabolic acidosis with bicarbonaturia • Glycosuria • Polyuria • Hyperkaelemia 19
- 20. Complications • Tubulopathies • Nephrotic syndrome • Acute kidney disease • Chronic kidney disease 20
- 21. Diagnosis • Medical and medication history • Clinical presentation • Renal function tests • Electrolyte levels • Urine microscopy • Creatinine clearance • CT scan of kidney and urinary tract • MRI of kidney and urinary tract • Kidney biopsy 21
- 22. Prevention and Treatment • Know about potentially nephrotoxic drugs • Identify high risk groups of patients • Avoid use of nephrotoxic drugs in high risk groups • Avoid use of combination of 2 or more nephrotoxic drugs • Adjust dose and duration of nephrotoxic drugs • Maintain adequate hydration while using nephrotoxic drugs • In severe cases of DIKD cases, go for renal replacement therapy 22
- 23. Tools to calculate eGFR 23
- 24. Resources • https://bmcnephrol.biomedcentral.com/track/pdf/10.1186/ s12882-017-0536-3 • https://cjasn.asnjournals.org/content/clinjasn/13/12/1897.f ull.pdf • file:///E:/TEST%20BOOK/DIKD%20ARTICLE.pdf • https://sci-hub.tw/10.2174/1389200218666171108154419 • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3794522/p df/ooomb4-20-268.pdf 24