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[Renal toxicity of antiviral drugs]
Giovanni M Frasca'1, Emilio Balestra, Marcello Tavio
1Nefrologia, Dialisi e Trapianto di Rene, Ospedali Riuniti, Ancona - Italy.
Abstract:
Highly effective and powerful antiviral drugs have been introduced into clinical practice in recent years which are associated with an increased incidence of nephrotoxicity. The need of combining several drugs, the fragility of the patients treated, and the high susceptibility of the kidney are all factors contributing to renal injury. Many pathogenetic mechanisms are involved in the nephrotoxicity of antiviral drugs, including drug interaction with transport proteins in the tubular cell; direct cytotoxicity due to a high intracellular drug concentration; mitochondrial injury; and intrarenal obstruction or stone formation due to the low solubility of drugs at a normal urinary pH. As a result, various clinical pictures may be observed in patients treated with antiviral drugs, ranging from tubular dysfunction (Fanconi syndrome, renal tubular acidosis, nephrogenic diabetes insipidus) to acute renal failure (induced by tubular necrosis or crystal nephropathy) and kidney stones. Careful attention should be paid to prevent renal toxicity by evaluating the glomerular filtration rate before therapy and adjusting the drug dosage accordingly, avoiding the combination with other nephrotoxic drugs, and monitoring renal parameters on a regular basis while treating patients.
Insights
New antiviral drugs offer powerful treatment but can cause kidney damage (nephrotoxicity). Careful patient monitoring and dose adjustment are crucial to prevent adverse renal effects during antiviral therapy.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Context:
- Recent advancements in antiviral therapies have led to improved patient outcomes.
- However, these potent medications are increasingly linked to significant kidney toxicity (nephrotoxicity).
- Factors such as polypharmacy, patient frailty, and kidney susceptibility exacerbate this risk.
Purpose:
- To elucidate the multifaceted pathogenetic mechanisms underlying antiviral drug-induced nephrotoxicity.
- To outline the diverse clinical manifestations of renal injury associated with antiviral treatments.
- To emphasize preventative strategies for mitigating renal toxicity in patients receiving antiviral therapy.
Summary:
- Antiviral drug nephrotoxicity involves complex mechanisms including tubular transport interactions, direct cytotoxicity, mitochondrial damage, and crystal nephropathy.
- Clinical presentations range from tubular dysfunction (e.g., Fanconi syndrome) to acute kidney injury and nephrolithiasis.
- Preventive measures include pre-therapy glomerular filtration rate assessment, dose adjustment, avoidance of concurrent nephrotoxic agents, and regular renal function monitoring.
Impact:
- Highlights the critical need for vigilance regarding renal safety in patients undergoing antiviral treatment.
- Provides a framework for clinicians to proactively manage and prevent kidney complications.
- Informs the development of safer antiviral drug regimens and patient management protocols.
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