What is the role of nephrotoxic agents in the treatment of acute kidney injury (AKI)?

Updated: Dec 24, 2020
  • Author: Biruh T Workeneh, MD, PhD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

In AKI, the kidneys are especially vulnerable to the toxic effects of various chemicals. All nephrotoxic agents (eg, radiocontrast agents, antibiotics with nephrotoxic potential, heavy metal preparations, cancer chemotherapeutic agents, nonsteroidal anti-inflammatory drugs [NSAIDs]) should be avoided or used with extreme caution. Similarly, all medications cleared by renal excretion should be avoided, or their doses should be adjusted appropriately.

A 2013 study indicated that triple therapy using nonsteroidal anti-inflammatory drugs (NSAIDs) with 2 antihypertensive medications—a diuretic along with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin-receptor blocker (ARB)—significantly increases the risk of hospitalization for AKI, particularly in the first 30 days of treatment with these drugs.

The retrospective, case-controlled study involved a cohort of 487,372 users of antihypertensive drugs between 1997 and 2008. During a mean follow-up of almost 6 years, 2215 cases of acute kidney injury were identified (incidence rate of 7 per 10 000 person-years), and each was compared with up to 10 matched controls. [52, 53]

A retrospective, observational cohort study of 500 adult patients who received vancomycin for ≥72 h found that the incidence of AKI correlated with vancomycin trough levels, ranging from 8.02% with first trough levels below 10 µg/mL to 31.82% with first trough levels of 20 µg/mL or higher On multivariate logistic regression, factors significantly associated with increased incidence of AKI included first or average trough levels above 15 µg/mL as well as methicillin-resistant Staphylococcus aureus infection and morbid obesity. [54]


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