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Nephrotoxicity

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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 toxicityEdit

CardiovascularEdit

Direct tubular effectEdit

Acute interstitial nephritisEdit

Main article : Acute interstitial nephritis

Chronic interstitial nephritisEdit

Acute glomerulonephritisEdit

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 insipidusEdit

Other nephrotoxinsEdit

  • Lead, mercury and cadmium salts
  • Aristolochic acid, found in some plants and in some herbal supplements derived from those plants, has been shown to have nephrotoxic effects on humans.
  • Rhubarb contains some nephrotoxins which can cause inflammation of the kidneys in some people.
  • Fumaric acid, aka food additive E297
  • Orellanine

DiagnosisEdit

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.

EtymologyEdit

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

See alsoEdit

ReferencesEdit

  1. ^ Galley HF (2000). "Can acute renal failure be prevented". J R Coll Surg Edinb. 45 (1): 44–50. PMID 10815380. Archived from the original on 2005-10-18.
  2. ^ a b 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. ^ a b USMLE WORLD QBanks 2009, Step1, Pharmacology, Q74

Further readingEdit

  • Choudhury, Devasmita; Ahmed, Ziauddin (2006). "Drug-associated renal dysfunction and injury". Nature Clinical Practice Nephrology. 2 (2): 80–91. doi:10.1038/ncpneph0076. PMID 16932399.
  • Szeto, CC; Chow, KM (2005). "Nephrotoxicity related to new therapeutic compounds". Renal Failure. 27 (3): 329–33. doi:10.1081/jdi-56595. PMID 15957551.