Diagnosis, Treatment and Prevention of Nephrotoxicity

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

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

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.

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