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Diagnosis, Treatment and Prevention of Nephrotoxicity

Last Updated on Jan 12, 2019
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How is Nephrotoxicity Diagnosed?

It is important to diagnose nephrotoxicity at an early stage. The physicians must be aware of nephrotoxic potential of drugs and the risks involved.

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Nephrotoxicity can be diagnosed with simple blood tests. However, these assessments help when the damage to kidney is extensive. These tests could include:

  • Serum creatinine levels in blood
  • Measurement of BUN (Blood urea nitrogen)
  • Creatinine clearance
  • Glomerular filtration rate

The use of biomarker helps in assessing nephrotoxicity at an early stage. Some of the biomarkers include:

  • Type IV Collagen - an important biomarker of nephrotoxicity- helps to indicate changes in glomerulus
  • Albumin- a high molecular weight protein used to indicate kidney damage for early diagnosis of changed glomerular filtration and diabetes
  • Transferrin - helps in transporting iron, is a strong indicator of glomerular damage
  • Cytokines - these biomarkers are involved in glomerular and tubular damage and repair
  • NGAL (Neutrophil gelatinase-associated lipocalin) - a sensitive biomarker for diagnosis of kidney injury
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How do you Treat Nephrotoxicity?

Nephrotoxicity can be treated by methods listed below:

  • The renal failure can be managed by maintaining the fluid volume in body, start dialysis or adjust drug doses
  • The drug causing nephrotoxicity must be discontinued or its dose be altered
  • In some conditions, steroid therapy may help
  • Maintaining electrolyte balance
Discontinue Nephrotoxic Drugs to Treat Drug-Induced Nephrotoxicity

What are the Common Risk Factors for Drug-induced Nephrotoxicity?

The common risk factors include:

  • Age above 60 years
  • Patient already suffering from Renal insufficiency
  • Sepsis
  • Heart failure
  • Diabetes
  • Patients with dehydration and extracellular volume depletion
  • Increased uric acid level or Hyperuricemia
  • Prior exposure to radio contrast agents for doing X-rays or CT scan.
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How do you Prevent Nephrotoxicity?

  • Limit intake of NSAID drugs and limit painkillers
  • Look out for words in prescription leaflet which indicate “could cause nephrotoxicity” and avoid using these drugs
  • Use alternate drugs which are non-nephrotoxic drugs
  • Monitor renal function during therapy and adjust dosage of drug depending on the vital signs
  • Be aware of patient risk factors and avoid drugs which could cause nephrotoxicity

References:

  1. Drug-Induced Nephrotoxicity - (https://www.aafp.org/afp/2008/0915/p743.html)
  2. Drug-induced Kidney Diseases - (http://www.japi.org/october2003/R-970.pdf)
  3. Drug-Induced Nephrotoxicity and Its Biomarkers - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3794522/)
  4. Drug-induced renal disorders - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4594214/)
  5. Pharmacology behind Common Drug Nephrotoxicities - (https://cjasn.asnjournals.org/content/early/2018/04/04/CJN.00150118)
  6. Nephrotoxicity and Renal Pathophysiology: A Contemporary Perspective - (https://www.ncbi.nlm.nih.gov/pubmed/29939355)
  7. Diagnosis, Treatment, and Prevention of Nephrotoxicity of Cancer Therapeutic Agents - (https://www.ncbi.nlm.nih.gov/books/NBK12686/)

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