Thiazide diuretics nephrotoxicity

Diuretics have been shown to have variable effects in relationship to urinary calcium excretion and supersaturation, most notably including loop diuretic induced hypercalciuria and attenuation of urinary calcium excretion by thiazide diuretics. The factors contributing to nephrotoxicity are most commonly associated with multiple factors that favor calcium salt or uric acid deposition at the tubulo-interstitial level. Management of renal stone formation and nephrocalcinosis therefore presents a unique clinical challenge, balancing factors that increase risk for abnormal calcium salt deposition or crystallization, and factors that reduce this risk. 

CICLOSPORIN LOOP DIURETICS, THIAZIDES Risk of nephrotoxicity Additive effect Monitor renal function weekly... 

Isolated cases of nephrotoxicity have been described when patients taking ciclosporin were given either amiloride with hydrochlorothiazide, metolazone, or mannitol. Furosemide can possibly protect the kidney against ciclosporin damage. The concurrent use of ciclosporin with thiazides, but not loop diuretics, may increase serum magnesium levels. The concurrent use of ciclosporin with potassium-sparing diuretics may cause hyperkalaemia. 

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