[Medication-induced impairment of renal function: what is important?].
Non-steroidal antiphlogistics and COX-2 inhibitors routinely cause sodium retention and a blood pressure increase by about 5 mmHg, a decrease in renal function (by about 10 ml/min) and in 1-2% an acute renal failure. Prevention is possible by short-term, low-dose application, avoidance of dehydration, controlling serum creatinine levels 1 week after start of treatment in high-risk groups. Aminoglycosides cause acute renal failure in 10-20% which can be prevented by once daily dosing, meticulous drug monitoring. Radio contrast media cause, mostly dependent on baseline renal function, in 0-50% a radiocontrast-induced nephropathy. This can be prohibited with hydration, low volume of contrast medium, and low- (or iso)osmolar contrast medium. New preparations of vancomycin go along with a greatly reduced rate of nephrotoxicity. Drug monitoring and avoidance of a combination therapy with aminoglycosides will help to reduce toxicity. Medication-induced acute interstitial nephritis is a relevant differential diagnosis in acute renal failure: stop implicated medication, consider steroid application!
Krämer
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BK
Klinik und Poliklinik für Innere Medizin II - Nephrologie, Universitätsklinikum Regensburg, Regensburg, Germany. bernhard.kraemer@klinik.uni-regensburg.de
Banas
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M
Banas
B
B
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D003287:Contrast Media / Q000009:adverse effects; D003422:Critical Care; D006801:Humans; D007677:Kidney Function Tests; D009395:Nephritis, Interstitial / Q000139:chemically induced; D012307:Risk Factors
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003287:Contrast Media