Medicines and the Kidney

exp date isn't null, but text field is

Medicines can lead to renal damage in a number of different ways and examples are given below. In the wrong circumstances life-saving medicines can do more harm than good. Doctors, pharmacists and nurses can help their patients by checking their treatment charts in hospital or at the outpatients department. The antimicrobials listed below may cause renal impairment and must therefore be stopped or not prescribed in patients with deteriorating renal function. All medicines in this table should be dosed based on kidney function (estimated GFR). Avoid concomitant use of nephrotoxic medications and diuretics. Monitor renal function before and during treatment. Patient-related risk factors for all these medicines include age, pre-existing chronic kidney disease, volume depletion, and concurrent use of nephrotoxic medicines. 

Antimicrobial	Risk Factor	Pathophysiology	Prevention
Aciclovir	High dose, IV bolus dose	Deposition of Aciclovir  crystal intratubular obstruction  and foci of interstitial  inflammation  crystal nephropathy  proximal tubulopathy	Avoid bolus dose, Prior hydration   (maintain urine  output > 75 ml/hour Slow drug infusion  over 1-2 hours
Aminoglycosides (e.g. gentamicin)	Dose, duration  and frequency of administration.  Concurrent renal  ischaemia or administration of nephrotoxins.  Liver disease  plasma  concentration  >10mg/dl peak	In proximal tubule  aminoglycoside bound to anionic phospholipid,  delivered to megalin,  endocytic uptake into  the cell. Within cell, accumulates –direct toxicity- AKI	Maintain therapeutic  range. Give once daily dose if necessary
Tenofovir	Dose, Duration	Tubular cell  karyomegaly, degeneration and  necrosis  interstitial nephritis,  AKI, Fanconi syndrome

AKI – Acute Kidney Injury