[Acute kidney failure induced by drugs or contrast media]

The incidence of in-hospital acute renal failure (ARF) due to drugs is estimated at 20% of all patients hospitalized for ARF. According to recent surveys, analgesic and non-steroidal anti-inflammatory drugs are now more frequently involved than antibiotics. The incidence of ARF in patients taking angiotensin-converting enzyme inhibitors is increasing. More than half of the patients have a non-oliguric course. Acute tubular necrosis and acute interstitial nephritis are found in most biopsied cases. The mortality rate ranges between 6% and 12%. Most patients recover but 15% to 20% have some degree of residual renal impairment, particularly older and oliguric patients, those with previous chronic renal insufficiency and whose ARF period is prolonged. The long-term renal effects of NSAIDs is a concern. ARF due to drugs is a preventable disease since two-thirds of patients received inappropriately high or prolonged doses of the offending drug and or were patients at risk to develop ARF.