Kidney Toxicity Handout

Question 1

What drugs are potential pre-renal toxins?

Answer 1

Diuretics
ACE inhibitors
ARBs
Antihypertensives

Question 2

What drugs vasoconstrictors could cause kidney toxicity?

Answer 2

NSAIDs
RADIOCONTRAST AGENTS
CYCLOSPORINE
Tacrolimus
Amphotericin B

Question 3

What drugs can cause toxicity through crystalluria?

Answer 3

Sulfonamides
MTX
Acyclovir
Triamterene
Protease inhibitors

Question 4

What drugs are potential toxins through tubular toxicity?

Answer 4

AMINOGLYCOSIDES
CISPLATIN
Vancomycin
Pentamidine
Radiocontrast

Question 5

What drugs can cause endothelial injury in the kidney?

Answer 5

CYCLOSPORINE
Mitomycin C
Tacrolimus
Cocaine
Conjugated estrogens
Quinine

Question 6

What drugs can cause glomerulopathy?

Answer 6

Penicillamine

NSAIDs

Question 7

What drugs can cause interstitial nephritis?

Answer 7

Antibiotics
NSAIDs
Diuretics

Question 8

What is the mechanism by which drugs induce endothelial injury?

Answer 8

Pro-inflammatory condition with detachment, release of chemotactic factors, reduced NO production

Question 9

How does acetaminophen damage the kidney?

Answer 9

Proximal tubule necrosis; inc BUN and Cr, lowers GFR; CYP activation implicated; glutathione conjugates may play a role

Question 10

How do NSAIDs damage the kidney?

Answer 10

3 mechanisms:

1) Inhibit PG synthesis, reducing ability of afferent arteriole to dilate during vasoconstriction
2) Analgesic nephropathy - chronic ingestion causes interstitial nephritis and papillary necrosis
3) Interstitial nephritis - acute - rarer

Question 11

How do aminoglycosides damage the kidney?

Answer 11

Increase number and size of lysosomes, which contain phospholipids. When these rupture, toxic contents are exposed to cytoplasm of tubule cells.

Question 12

How does amphotericin B damage the kidneys?

Answer 12

Impairs function of glomerulus, proximal, and distal tubules. Reduces renal bloodflow and GFR

Question 13

How does cyclosporine damage the kidneys?

Answer 13

VASOCONSTRICTION & ENDO DAMAGE
Produces acute, reversible renal dysfunction and vasculopathy.

Vasoconstriction
Vasodilatory PGs
ATII
Endothelial PAF
Reduced endothelium relaxation

Question 14

How does cisplatin damage the kidneys?

Answer 14

TUBULE TOXICITY

Inhibits DNA synthesis, causing focal necrosis in nephron while not affecting glomerulus. Can result in PERMANENT loss of 10-30% of renal fxn.

Question 15

How do radiocontrast dyes damage the kidneys?

Answer 15

Extremely nephrotoxic - up to 10% of pts w normal kidneys have damage from IOTROL or IOPAMIDOL

In pts with risk factors, up to 50%

Damage arises from acute vasoconstriction and generation of ROS by cells (so direct tubule damage and indirect blood deprivation)