Appendix 6: Drug-Induced Kidney Disease

Acute tubular necrosis

• Aminoglycoside antibiotics

• Radiographic contrast media

• Cisplatin, carboplatin

• Amphotericin B

• Cyclosporine, tacrolimus

• Adefovir, cidofovir, tenofovir

• Pentamidine

• Foscarnet

• Zoledronate

Osmotic nephrosis

• Mannitol

• Dextran

• IV immunoglobulin

• Angiotensin-converting enzyme inhibitors

• Angiotensin II receptor blockers

• Nonsteroidal anti-inflammatory drugs (NSAIDs)

• Cyclosporine, tacrolimus

• OKT3

Crystal nephropathy

• Acyclovir

• Sulfonamides

• Indinavir

• Foscarnet

• Methotrexate

Nephrolithiasis

• Sulfonamides

• Triamterene

• Indinavir

Nephrocalcinosis

• Oral sodium phosphate solution

Minimal change disease

• NSAIDs, COX-2 inhibitors

• Lithium

• Pamidronate

• Interferon-α and -β

Membranous disease

• NSAIDs

• Penicillamine

• Captopril

Focal Segmental Glomerulosclerosis

• Pamidronate

• Interferon-α and -β

• Lithium

• Sirolimus

• Anabolic steroids

Acute allergic interstitial nephritis

• Penicillins

• Ciprofloxacin

• NSAIDs, cyclooxygenase-2 inhibitors

• Proton pump inhibitors

• Loop diuretics

Chronic interstitial nephritis

• Cyclosporine

• Lithium

• Aristolochic acid

Papillary necrosis

• NSAIDs, combined phenacetin, aspirin, and caffeine analgesics

Vasculitis and thrombosis

• Hydralazine

• Propylthiouracil

• Allopurinol

• Penicillamine

• Gemcitabine

• Mitomycin C

• Methamphetamines

• Cyclosporine, tacrolimus

• Adalimumab

• Bevacizumab

Cholesterol emboli

• Warfarin

• Thrombolytic agents

(A) Related to aminoglycoside dosing:

Large total cumulative dose

Prolonged therapy

Trough concentration exceeding 2 mg/L^a

Recent previous aminoglycoside therapy

(B) Related to synergistic nephrotoxicity. Aminoglycosides in combination with

Cyclosporine

Amphotericin B

Vancomycin

Diuretics

Iodinated radiographic contrast agents

Cisplatin

NSAIDs

(C) Related to predisposing conditions in the patient

Preexisting kidney disease

Diabetes

Increased age

Poor nutrition

Shock

Gram-negative bacteremia

Liver disease

Hypoalbuminemia

Obstructive jaundice

Dehydration

Hypotension

Potassium or magnesium deficiencies

• Minimize contrast volume/dose

• Use noniodinated contrast studies

• Use low- or iso-osmolar contrast agents

A-1

A-2

A-2

• Avoid concurrent use of potentially nephrotoxic drugs, eg, NSAIDs, aminoglycosides

• Initiate infusion 3–12 hours prior to contrast exposure and continue 6–24 hours postexposure

• Infuse at 1–1.5 mL/kg/h adjusting postexposure as needed to maintain a urine flow rate of 150 mL/h

• Alternatively, in urgent cases, initiate infusion at 3 mL/kg/h, beginning 1 hour prior to contrast exposure, then continue at 1 mL/kg/h for 6 hours postexposure

• Administer 600–1200 mg by mouth (PO) every 12 hours, 4 doses beginning prior to contrast exposure (ie, 1 dose prior to exposure and 3 doses postexposure)