Drug-induced acute kidney injury in children.
Acute kidney injury (AKI) is a serious problem occurring in anywhere between 8 and 30% of children in the intensive care unit. Up to 25% of these cases are believed to be the result of pharmacotherapy. In this review we have focused on several relevant drugs and/or drug classes, which are known to cause AKI in children, including cancer chemotherapeutics, non-steroidal anti-inflammatory drugs and antimicrobials. AKI demonstrates a steady association with increased long term risk of poor outcomes including chronic kidney disease and death as determined by the extent of injury. For this reason it is important to understand the causality and implications of these drugs and drug classes. Children occupy a unique patient population, advocating the importance of understanding how they are affected dissimilarly compared with adults. While the kidney itself is likely more susceptible to injury than other organs, the inherent toxicity of these drugs also plays a major role in the resulting AKI. Mechanisms involved in the toxicity of these drugs include oxidative damage, hypersensitivity reactions, altered haemodynamics and tubule obstruction and may affect the glomerulus and/or the tubules. Understanding these mechanisms is critical in determining the most effective strategies for treatment and/or prevention, whether these strategies are less toxic versions of the same drugs or add-on agents to mitigate the toxic effect of the existing therapy.
Department of Physiology and Pharmacology, Western University, London, Ontario, Canada.|Ivey Chair in Molecular Toxicology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Lauren N
LN
Faught
Robarts Research Institute, London, Ontario, Canada.
Michael J E
http://orcid.org/0000-0002-8728-9673
MJ
Greff
Department of Physiology and Pharmacology, Western University, London, Ontario, Canada.|Department of Pediatrics, Western University, London, Ontario, Canada.|CIHR-GSK Chair in Paediatric Clinical Pharmacology, Children's Hospital of Western Ontario, London, Ontario, Canada.|Department of Medicine, Western University, London, Ontario, Canada.
Michael J
MJ
Rieder
Department of Physiology and Pharmacology, Western University, London, Ontario, Canada.|Ivey Chair in Molecular Toxicology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.|Department of Pediatrics, Western University, London, Ontario, Canada.|Department of Medicine, Western University, London, Ontario, Canada.|Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada.|Department of Pharmacology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Gideon
G
Koren
D058186:Acute Kidney Injury / Q000139:chemically induced*; D000890:Anti-Infective Agents / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D006801:Humans; D012307:Risk Factors
D000890:Anti-Infective Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000970:Antineoplastic Agents
ADR; NSAID; antimicrobials; chemotherapeutics; drug-induced AKI