Renal disease drug-related

Variable factors are coexisting diseases (diabetes, liver or renal disease, endocrinopathies), overweight, malnutrition (e.g. lack of protein), alcohol, additional medication, tobacco smoke particles, heavy metals and pregnancy as well as drug-related overdose, longterm intake or application form, etc. (s. tab. 3.18)... 

A case-control study on recent use of NSAIDs and functional renal impairment at the time of hospitalization showed that there was a weak association between the use of NSAIDs and renal dysfunction. Patients at higher risk had a history of renal disease or of gout and hyperuricemia. While NSAID dosages were only weakly related to renal impairment, there was a statistically significant difference between compounds with half-lives under or over 4 hours the OR increased from 1.2 (95% Cl = 0.6,2.4) to 4.8 (Cl = 1.5, 16) for compounds with half-lives over 12 hours (156). Therefore, long half-life drugs should be avoided in subjects at risk of renal impairment. 

In a prospective study of renal disease in 235 patients with early rheumatoid arthritis, persistent proteinuria and a raised serum creatinine concentration were predominantly related to drugs, including penicillamine and other DMARDs, whereas isolated hematuria was more directly associated with the activity of the disease process (205). Risk factors for drug-induced proteinuria were raised C-reactive protein, raised erythrocyte sedimentation rate, and age over 50 years. 

The illicit use of drugs involves millions of people worldwide and is associated with a variety of medical complications. In recent years the abuse of both heroin and cocaine have produced major medical problems across the globe. Other illicit agents such as barbiturates, ethyl alcohol, amphetamines, and phencyclidine, as well as drug combinations produce medical complications as well, sometimes with renal manifestations (Table 1). An estimate of 5-6 % of new patients beginning treatment for end stage renal disease in the United States appear to have opiate-related kidney disease [1]. 

As with other cases of ARF, ARF due to drugs is most often the consequence of multiple simultaneous insults. For example, Rasmussen and Ibels [4] found that 62% of 143 patients had more than one acute insult, including excessive aminoglycoside exposure and radiocontrast material administration. In the series of Davidman et al, [14], multiple causes of ARF were also present in 50% of 38 patients with drug-related renal disease. 

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