Moving toward a contemporary classification of drug-induced kidney disease

Area of Science:

• Nephrology
• Pharmacology
• Clinical Medicine

Background:

• Drug-induced kidney disease (DIKD) constitutes a significant portion of acute kidney injury (AKI) cases, particularly in critically ill patients.
• Existing diagnostic criteria for DIKD lack standardization, hindering consistent clinical and research application.
• Previous efforts include a 2015 expert consensus phenotype definition for DIKD.

Purpose of the Study:

• To introduce and describe a novel framework for classifying drug-induced kidney disease (DIKD).
• To stratify medications into categories based on kidney functional changes and tissue damage biomarkers.
• To discuss the implications, clinical adoption, and potential patient pathway shifts within this new DIKD classification system.

Main Methods:

• A novel DIKD classification framework incorporating functional change and tissue damage biomarkers was proposed.
• Medications were categorized into four distinct groups: 'dysfunction without damage,' 'damage without dysfunction,' 'both dysfunction and damage,' and 'neither dysfunction nor damage.'
• Mechanisms of nephrotoxicity for various drugs and drug classes were analyzed in relation to the proposed categories.

Main Results:

• The proposed framework stratifies drugs into four categories based on kidney dysfunction and damage.
• Mechanisms of nephrotoxicity and examples of associated drugs/drug classes are provided for each category.
• The framework allows for consideration of patient disease progression between categories under specific clinical conditions.

Conclusions:

• The novel DIKD classification framework offers improved clarity and consistency for clinicians and researchers.
• This system aligns DIKD categorization with existing acute kidney injury (AKI) classification frameworks.
• Opportunities and barriers for adopting this new DIKD classification in clinical practice are discussed.