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Toxic Nephropathy Due to Drugs and Poisons

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Management of Acute Kidney Problems

Abstract

Drug-induced acute renal failure (ARF) is increasingly encountered, especially in hospitalized patients as a result of a more aggressive diagnostic and therapeutic measures in an ageing and multimedicated patient population that is increasingly vulnerable. Potentially nephrotoxic drugs include nonsteroidal antiinflammatory drugs, radiocontrast agents, antimicrobial, and anesthetic agents. Endogenous compounds such as myoglobin and hemoglobin may also cause toxic nephropathy. Tubular injury initiated by toxins often results from a combination of acute renal vasoconstriction and direct cellular toxicity due to intracellular accumulation of the toxin, or, alternatively, may be mediated immunologically in case of interstitial nephritis. Patients with reduced renal functional reserve, cardiovascular comorbidity, diabetes mellitus, and advanced age are at increased risk. Awareness of the range of toxins on the one hand, and simple measures such as adequate prehydration of the patient and drug monitoring, on the other hand, may be sufficient to avoid drug-induced ARF or minimize its clinical severity in susceptible patients.

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Acknowledgments

The author thanks B. Sprangers, MD, for his helpful comments and suggestions.

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Authors and Affiliations

  1. Department of Nephrology, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium

    Pieter Evenepoel

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  1. Pieter Evenepoel
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  1. Charité Campus Virchow, Universitätsklinikum Berlin, Augustenburger Platz 1, Berlin, 13353, Germany

    Achim Jörres

  2. Dipto. Nefrologia, Ospedale San Bortolo, Viale Rodolfi 16, Vicenza, 36100, Italy

    Claudio Ronco

  3. School of Medicine, University of Pittsburgh, Terrace Street 3550, Pittsburgh, 15261, U.S.A.

    John A. Kellum

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Evenepoel, P. (2010). Toxic Nephropathy Due to Drugs and Poisons. In: Jörres, A., Ronco, C., Kellum, J. (eds) Management of Acute Kidney Problems. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-69441-0_33

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