Acute kidney injury drugs

Mechanisms of drug induced acute kidney injury... 

Traditionally, when searching for the etiology of AKI, the clinician s will subdivides the potential causes of a sudden decline of GFR into one of three general pathophysiologic processes pre renal failure, intrarenal failure or post renal failure [1]. Recently, Miet et al [ 52] in discussing drug-induce acute kidney injury detailed two additional mechanisms that need to be considered in addition to those outlined in Table 2. 

Table 2. Classification of various drugs based on pathophysiologic categories of acute kidney injury.

Crystal deposition Particularly important with acyclovir and indinavir, but also noted with sulfonamides, methotrexate and triamterene. This mechanism is becoming more recognized due to the rise in the incidence of tumor-lysis syndrome with AKI. Acute kidney injury caused by tubular obstruction can also occur with a number of drugs (Table 2), due to intratubular precipitation of the... 

Zhang et al [79] recently reported the results of renal biopsies in 104 cases of acute kidney injury complicating CKD. Drug related acute tubulointerstitial neprhritis accounted for 31% of all cases, while an additional 5% had evidence of drug-related acute tubular necrosis by biopsy. NSAIDs were the most common drug responsible for the AKI. 

Drug-associated acute kidney injury in the intensive care unit... 

Schetz M, Dasta J, Goidstein S, and GoiperT. 2005. Drug-induced acute kidney injury. CurrOpin Crit Care 11 555-565. 

Diuretics are among the most frequently prescribed drugs for the treatment of both edematous and non-edematous states. With respect to the latter category, they are most often utilized in the therapy of hypertension. They may injure the kidney either reversibly or irremediably, a distinction which often depends upon whether they have induced functional or anatomic damage. Ordinarily, the former type of disorder reverses more rapidly than the latter. However, anatomical lesions, for example those that may be associated with acute kidney injury, may also respond to the removal of the offending agent. 

Heroin nephropathy/clinical course Amyloidosis associated with intravenous drug abuse HIV nephropathy and its relationship to heroin nephropathy Acute kidney injury due to drug-induced rhabdomyolysis Cocaine-induced renal disease 598 599 601 603 605... 

Acute kidney injury due to drug-induced rhabdomyolysis... 

Almost half of the reported patients with acute kidney injury due to rhabdomyolysis have required dialy tic support. Nevertheless, the majority of patients regain significant renal function. The mortality from drug-induced rhabdomyolysis and ATN has been low despite the common occurrence of intercurrent infection. This may be related to the patients being young and without prior multisystem disease. 

The etiology of the acute kidney injury may be related to isometric tension in restrained limbs or to ischemic damage to muscle in the presence of hyperthermia and/or limb compression [161, 166]. While it is possible that the drug itself may possess direct myopathic toxicity when abused in certain settings, it does not induce rhabdomyolysis in unrestrained animals [167]. Animals restrained in immobilizing cages, however, develop rhabdomyolysis, which correlates with isometric muscle tension during the restrained period which can be prevented by prior denervation [167]. 

Ecstacy (MDMA methylenedioxymethamphetamine) use has been a fast growing new form of drug abuse in the USA and has been implicated as a cause of rhabdomyolysis and acute kidney injury [2]. Ironically, efforts to pre-empt overheating and dehydration... 

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