The interpretation of incidence data of renal adverse reactions is hampered by the absence of a uniform definition.
EPIDEMIOLOGY
The
interpretation of incidence data of renal adverse reactions is hampered by the
absence of a uniform definition. However, drug-induced nephrotoxicity is a major
cause of hospital-acquired ARF contributing to 4–19% of the cases (Hou et al., 1983; Shusterman et al., 1987; Nash, Hafeez and Hou,
2002; Payen and Berton, 2005), also
in developing coun-tries (Jha et al.,
1992). Antibiotics (aminoglyco-sides, amphotericin B and piperacillin),
non-steroidal anti- inflammatory drug (NSAIDs), cyclosporine and
angiotensin-converting enzyme (ACE) inhibitors are high on the list (Nash,
Hafeez and Hou, 2002). Especially in the setting of the intensive care unit
(ICU), drug-induced renal failure is very frequent. The reason is that many
precipitating factors such as hypovolaemia, true hypovolaemia or reduced
effec-tive circulating volume, sepsis, older age and the concomitant
administration of other nephrotoxins, are present in ICU patients.
In
the general community, drug-induced ARF is rare (Liano and Pascual, 1996),
although its incidence may be growing due to the increased use of ACE
inhibitors in combination with diuretics in the elderly population (Baraldi et al., 1998). In children drugs are a
rare cause of ARF (Moghal, Brocklebank and Meadow, 1998).
Renal
adverse effects also contribute to the burden of chronic renal disease. In the
1980s, in some coun-tries like Belgium, Switzerland and Australia, up to 20% of
dialysis patients were suffering from anal-gesic nephropathy. In these
patients, renal papillary necrosis induced by chronic abuse of analgesics lead
to CRF. Prospective studies firmly linked the disease to the chronic use of
analgesic mixtures. The rela-tionship has been established for mixtures
containing phenacetin (Dubach, 1983) as well as for mixtures not containing
phenacetin (Elseviers and De Broe, 1995). In the same patients, urinary tract
tumours were also more prevalent. Nowadays, the disease is disappear-ing
following legislative measures limiting the free access to the incriminated
drugs.
The
calcineurin inhibitors cyclosporine and tacrolimus are immunosuppressant agents
used after organ transplantation and in the treatment of psoriasis and
autoimmune diseases. The main adverse effect of these drugs not related to
their immunosuppres-sive action is nephrotoxicity. Calcineurin nephrotox-icity
is an important contributor to the development of chronic graft failure after
kidney transplantation and may lead to end-stage renal disease in heart and
liver allograft recipients. Even short-time courses of cyclosporine may induce
structural damage in psori-asis patients (Vercauteren et al., 1998).
Related Topics
TH 2019 - 2024 pharmacy180.com; Developed by Therithal info.