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Drug-associated renal dysfunction and injury

Nature Clinical Practice Nephrology volume 2, pages 80–91 (2006)Cite this article

Abstract

Renal dysfunction and injury secondary to medications are common, and can present as subtle injury and/or overt renal failure. Some drugs perturb renal perfusion and induce loss of filtration capacity. Others directly injure vascular, tubular, glomerular and interstitial cells, such that specific loss of renal function leads to clinical findings, including microangiopathy, Fanconi syndrome, acute tubular necrosis, acute interstitial nephritis, nephrotic syndrome, obstruction, nephrogenic diabetes insipidus, electrolyte abnormalities and chronic renal failure. Understanding the mechanisms involved, and recognizing the clinical presentations of renal dysfunction arising from use of commonly prescribed medications, are important if injury is to be detected early and prevented. This article reviews the clinical features and basic processes underlying renal injury related to the use of common drugs.

Key Points

  • Renal injury caused by medication can usually be reversed if detected early

  • Drug-induced renal damage can be acute or chronic, prerenal, intrarenal (vascular, tubular, glomerular or interstitial) or postrenal

  • Different drug classes share common mechanisms of inducing renal injury (e.g. toxic, ischemic, inflammatory, obstructive or volume depletion)

  • Electrolyte/acid–base abnormalities are common effects of some medications

  • Medications that can cause kidney damage include diuretics, antihypertensives, immunosuppressants, antiplatelet agents, antivirals, chemotherapeutics, antibiotics and radiocontrast agents

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Acknowledgements

The authors would like to sincerely thank the Dallas Veterans Affairs Hospital Library and Medical Media Section for their prompt responses in obtaining pertinent papers and creating the tables presented in this article.

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  1. University of Texas Southwestern Medical Center, and Director of Dialysis at the Veterans Affairs North Texas Health Care System, Dallas, TX

    Devasmita Choudhury

  2. Dialysis Unit at Drexel University College of Medicine, Philadelphia, PA, USA

    Ziauddin Ahmed

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Correspondence to Devasmita Choudhury.

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Choudhury, D., Ahmed, Z. Drug-associated renal dysfunction and injury. Nat Rev Nephrol 2, 80–91 (2006). https://doi.org/10.1038/ncpneph0076

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