title: Medication-Induced Nephrotoxicity in Older Patients.
abstract: OBJECTIVE
  To summarize current evidence about mechanisms, clinical features, diagnostic issues, and strategies for prevention of medication-induced nephrotoxicity among older people.
  
  
  METHODS
  A Pubmed search was performed, and studies concerning age-related changes in kidney structure and function predisposing to nephrotoxicity, pathophysiological mechanisms, kidney drug metabolism enzymes, clinical epidemiology of medication-induced kidney damage, biomarkers for early identification of nephrotoxicity and strategies for prevention of medication-induced nephrotoxicity among older people were selected. Finally, 245 papers were included in the review.
  
  
  RESULTS
  Medications may induce nephrotoxicity through several pathophysiological mechanisms. People aged 75 or more are especially exposed to potential nephrotoxic medications or combinations of medications in the context of complex polypharmacy regimens. Estimated glomerular filtration rate (eGFR) may be useful to identify medication-induced alterations in kidney function, but creatinine-based methods have important limitation in older patients. Several innovative biomarkers have been proposed to identify AKI but these methodologies are not standardized and older people have not been evaluated systematically. Factors related to patient, medication, and interactions should be taken into account for effective prevention.
  
  
  CONCLUSIONS
  Medication-induced nephrotoxicity is a relevant problem in older populations. Nevertheless, several areas of uncertainty remain to be explored, including the impact of nephrotoxicity on functional outcomes relevant to older patients, the reliability of currently recommended methods for diagnosing and staging AKI, the use of innovative biomarkers in such a heterogeneous population, the effectiveness of preventing strategies and treatments and their impact on functional outcomes.
authors.forename: Sergio
authors.initials: S
authors.lastname: Fusco
authors.forename: Sabrina
authors.initials: S
authors.lastname: Garasto
authors.affiliation: Unit of Geriatric Pharmacopidemiology, Italian National Research Centre on Aging, C. da Muoio Piccolo, 87100 Cosenza, Italy. andrea_corsonello@tin.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Corsonello
authors.forename: Silvio
authors.initials: S
authors.lastname: Vena
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mari
authors.forename: Pietro
authors.initials: P
authors.lastname: Gareri
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ruotolo
authors.forename: Filippo
authors.initials: F
authors.lastname: Luciani
authors.forename: Arturo
authors.initials: A
authors.lastname: Roncone
authors.forename: Marcello
authors.initials: M
authors.lastname: Maggio
authors.forename: Fabrizia
authors.initials: F
authors.lastname: Lattanzio
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D000367:Age Factors; D000368:Aged; D000375:Aging; D015415:Biomarkers / Q000378:metabolism; D015897:Comorbidity; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology; D008875:Middle Aged; D019338:Polypharmacy; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers