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Drug-induced nephropathies.

M S Paller1

  • 1University of Minnesota, Minneapolis.

The Medical Clinics of North America
|July 1, 1990
PubMed
Summary

Drug-induced kidney disease presents various syndromes, with acute tubular necrosis being most common. Prevention involves avoiding specific nephrotoxic drugs in at-risk patients.

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Area of Science:

  • Nephrology
  • Pharmacology
  • Toxicology

Background:

  • Drug-induced renal disease is a significant clinical issue.
  • Various renal syndromes can result from medication use, including prerenal azotemia, electrolyte disturbances, acute tubular necrosis (ATN), acute interstitial nephritis (AIN), and chronic interstitial nephritis (CIN).

Purpose of the Study:

  • To review the common renal syndromes caused by drugs.
  • To highlight the most frequent causes and management strategies for drug-induced nephropathies.

Main Methods:

  • Literature review of drug-induced renal syndromes.
  • Categorization of renal syndromes based on etiology and clinical presentation.
  • Identification of causative agents and risk factors for each syndrome.

Main Results:

  • Acute tubular necrosis (ATN) is the most common syndrome, frequently caused by aminoglycoside antibiotics, radiographic contrast agents, and amphotericin B.
  • Acute interstitial nephritis (AIN) is an immune-mediated process often linked to penicillins, diuretics, allopurinol, NSAIDs, cimetidine, and sulfonamides.
  • Chronic interstitial nephritis (CIN) typically arises from prolonged use of analgesics (aspirin, acetaminophen, NSAIDs) and can lead to renal failure and increased cancer risk; cyclosporine can also cause CIN.

Conclusions:

  • Avoiding nephrotoxic drugs in high-risk patients (e.g., volume-depleted, pre-existing renal disease) is crucial for preventing ATN.
  • Early detection and drug withdrawal are key to managing AIN.
  • Long-term analgesic use poses risks for CIN, papillary necrosis, and urothelial carcinoma.

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