Nephrotoxicity

Nephrotoxicity is toxicity in the kidneys. It is a poisonous effect of some substances, both toxic chemicals and medications, on renal function. There are various forms,[1] and some drugs may affect renal function in more than one way. Nephrotoxins are substances displaying nephrotoxicity.

Nephrotoxicity should not be confused with the fact that some medications have a predominantly renal excretion and need their dose adjusted for the decreased renal function (e.g., heparin).

The nephrotoxic effect of most drugs is more profound in patients already suffering from kidney failure.

Types of toxicity

Cardiovascular

Direct tubular effect

Acute interstitial nephritis

Chronic interstitial nephritis

Acute glomerulonephritis

Drug-induced glomerular disease is not common but there are a few drugs that have been implicated. Glomerular lesions occur primarily through immune-mediated pathways rather than through direct drug toxicity.

Causes of diabetes insipidus

Other nephrotoxins

Surveillance

Nephrotoxicity is usually monitored through a simple blood test. A decreased creatinine clearance indicates poor renal function. Normal creatinine level is between 80 - 120 μmol/L. In interventional radiology, a patient's creatinine clearance levels are all checked prior to a procedure.

Serum creatinine is another measure of renal function, which may be more useful clinically when dealing with patients with early kidney disease.

Etymology and pronunciation

The word nephrotoxicity (/ˌnɛfrtɒkˈsɪsti/) uses combining forms of nephro- + tox- + -icity, yielding "kidney poisoning".

See also

References

  1. Galley HF (2000). "Can acute renal failure be prevented". J R Coll Surg Edinb. 45 (1): 44–50. PMID 10815380.
  2. 1 2 Naesens M, Kuypers DR, Sarwal M (2009). "Calcineurin inhibitor nephrotoxicity". Clin. J. Am. Soc. Nephrol. 4 (2): 481–509. doi:10.2215/CJN.04800908. PMID 19218475.
  3. 1 2 USMLE WORLD QBanks 2009, Step1, Pharmacology, Q74

Further reading

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