SlideShare a Scribd company logo
Drug induced kidney disease
Dr. V. S. Swathi
Assistant Professor
1
Definition
It is defined as abrupt or gradual loss of renal function due to
drugs and is characterised by increased serum creatinine
value and blood urea nitrogen which is having temporal
relationship between renal toxicity and drug
2
Epidemiology
• Acute tubular necrosis is most common cause of drug
induced kidney disease in hospitalised patients
• Mostly this problem is reversible with discontinuation of
offending agent but sometimes it is irreversible even after
withdrawl of drug
• In adults, it is approximately 14-26% in prospective studies of
acute kidney injury
• In paediatric population, it is responsible for 16% of drug
induced Acute kidney injury which leads to hospitalisation
• In India, it leads to 20% of total acute kidney injury cases
3
Risk factors
• Increased age
• Alcohol abuse
• Pre existing kidney disease
• Critically ill patients
• Large total cumulative dose of drugs
• Prolonged therapy of nephrotoxic drugs
• Concomitant therapy of 2 or more nephrotoxic drugs
• Diabetes
• Poor nutrition
• Shock
• Liver diseases
• Dehydration
• Hypotension
• Cardiovascular diseases
• Administration of contrast media
4
Causes
Tubular epithelial cell damage
• Acute tubular necrosis
• Aminoglycosides
• Amphotericin B
• Antiviral drugs
• Anticancer drugs
• Radiographic contrast media
Osmotic nephrosis
• Mannitol
• Sucrose
• IV immunoglobulin 5
Causes continued….
Hemodynamically mediated kidney injury
• Angiotensin converting enzyme inhibitors
• Angiotensin receptor blockers
• Non steroidal anti inflammatory drugs
6
Causes continued….
Obstructive nephropathy
Crystal nephropathy
• Anti viral drugs
• Sulphonamides
• Methotrexate
Nephrolithiasis
• Sulphonamides
Nephrocalcinosis
• Oral sodium phosphate solution 7
Causes continued….
Glomerular disease
Minimal change disease
• Non steroidal anti inflammatory drugs
• Lithium
Focal segmental Glomerulosclerosis
• Interferon alpha and beta
• Anabolic steroids
Membranous disease
• Non steroidal anti inflammatory drugs
• Captopril
8
Causes continued….
Tubulointerstitial disease
Acute allergic interstitial nephritis
• Pencillins
• Ciprofloxacin
• Non steroidal anti inflammatory drugs
• Proton pump inhibitors
• Loop diuretics
Chronic interstitial nephritis
• Lithium
• Cyclosporine
Papillary necrosis
• Non steroidal anti inflammatory drugs
• Aspirin
• Caffeine 9
Causes continued….
Renal Vasculitis, thrombosis and cholesterol emboli
Vasculitis and Thrombosis
• Allopurinol
• Propylthiouracil
Cholesterol emboli
• Warfarin
• Thrombolytic agents
10
Pathogenesis
11
Pathogenesis continued….
12
Pathogenesis continued….
13
Pathogenesis continued….
14
Pathogenesis continued….
15
Pathogenesis continued….
16
17
18
Clinical presentation
• Decrease in glomerular filtration rate
• Increase in serum creatinine and blood urea nitrogen
• Malaise
• Anorexia
• Vomiting
• Oedema
• Shortness of breath
• Decreased urine output
• Metabolic acidosis with bicarbonaturia
• Glycosuria
• Polyuria
• Hyperkaelemia 19
Complications
• Tubulopathies
• Nephrotic syndrome
• Acute kidney disease
• Chronic kidney disease
20
Diagnosis
• Medical and medication history
• Clinical presentation
• Renal function tests
• Electrolyte levels
• Urine microscopy
• Creatinine clearance
• CT scan of kidney and urinary tract
• MRI of kidney and urinary tract
• Kidney biopsy
21
Prevention and Treatment
• Know about potentially nephrotoxic drugs
• Identify high risk groups of patients
• Avoid use of nephrotoxic drugs in high risk groups
• Avoid use of combination of 2 or more nephrotoxic drugs
• Adjust dose and duration of nephrotoxic drugs
• Maintain adequate hydration while using nephrotoxic drugs
• In severe cases of DIKD cases, go for renal replacement
therapy
22
Tools to calculate eGFR
23
Resources
• https://bmcnephrol.biomedcentral.com/track/pdf/10.1186/
s12882-017-0536-3
• https://cjasn.asnjournals.org/content/clinjasn/13/12/1897.f
ull.pdf
• file:///E:/TEST%20BOOK/DIKD%20ARTICLE.pdf
• https://sci-hub.tw/10.2174/1389200218666171108154419
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3794522/p
df/ooomb4-20-268.pdf
24

More Related Content

What's hot

Prescribing guidelines for pregnancy and lactation by Dr.Prudhvi
Prescribing guidelines for pregnancy and lactation by Dr.PrudhviPrescribing guidelines for pregnancy and lactation by Dr.Prudhvi
Prescribing guidelines for pregnancy and lactation by Dr.Prudhvi
vallampati prudhvi
 
Introduction to rational use of drugs and role of pharmacist in rational use...
Introduction to  rational use of drugs and role of pharmacist in rational use...Introduction to  rational use of drugs and role of pharmacist in rational use...
Introduction to rational use of drugs and role of pharmacist in rational use...
Adhin Antony Xavier
 
BASIC PRINCIPLES OF CANCER CHEMOTHERAPY- THIRD PHARM.D
BASIC PRINCIPLES OF CANCER CHEMOTHERAPY- THIRD PHARM.DBASIC PRINCIPLES OF CANCER CHEMOTHERAPY- THIRD PHARM.D
BASIC PRINCIPLES OF CANCER CHEMOTHERAPY- THIRD PHARM.D
APOLLO JAMES
 
General prescribing guidelines_for_pregnancy_and_breast_feeding
General prescribing guidelines_for_pregnancy_and_breast_feedingGeneral prescribing guidelines_for_pregnancy_and_breast_feeding
General prescribing guidelines_for_pregnancy_and_breast_feeding
Venkata subbareddy Bareddy
 
Pharmacotherapy of renal failure
Pharmacotherapy of renal  failurePharmacotherapy of renal  failure
Pharmacotherapy of renal failure
Muhammed Rashid Ak
 
Drug induced hematological disorders @rxvichu!!!
Drug induced hematological disorders @rxvichu!!!Drug induced hematological disorders @rxvichu!!!
Drug induced hematological disorders @rxvichu!!!
RxVichuZ
 
GENERAL PRESCRIBING GUIDELINES FOR PAEDIATRIC PATIENTS.pptx
GENERAL PRESCRIBING GUIDELINES FOR PAEDIATRIC PATIENTS.pptxGENERAL PRESCRIBING GUIDELINES FOR PAEDIATRIC PATIENTS.pptx
GENERAL PRESCRIBING GUIDELINES FOR PAEDIATRIC PATIENTS.pptx
kavitharaninachiya
 
Drug Induced Liver Disorder
Drug Induced Liver DisorderDrug Induced Liver Disorder
Drug Induced Liver Disorder
MerlinMathews3
 
Drug Induced Renal Disease.pptx
Drug Induced Renal Disease.pptxDrug Induced Renal Disease.pptx
Drug Induced Renal Disease.pptx
Shivaji University
 
Rheumatoid Arthritis - Pharmacotherapy
Rheumatoid Arthritis - Pharmacotherapy Rheumatoid Arthritis - Pharmacotherapy
Rheumatoid Arthritis - Pharmacotherapy
Areej Abu Hanieh
 
Drug Induced Pulmonary Diseases
Drug Induced Pulmonary DiseasesDrug Induced Pulmonary Diseases
Drug Induced Pulmonary Diseases
Health Forager
 
Drug induced renal failure By Shaista Sumayya
Drug induced renal failure By Shaista SumayyaDrug induced renal failure By Shaista Sumayya
Drug induced renal failure By Shaista Sumayya
PARUL UNIVERSITY
 
Pharmacotherapy of Rheumatoid arthritis
Pharmacotherapy of Rheumatoid arthritisPharmacotherapy of Rheumatoid arthritis
Pharmacotherapy of Rheumatoid arthritis
Koppala RVS Chaitanya
 
General prescribing guidelines for Pediatrics geriatrics pregnancy lactating...
 General prescribing guidelines for Pediatrics geriatrics pregnancy lactating... General prescribing guidelines for Pediatrics geriatrics pregnancy lactating...
General prescribing guidelines for Pediatrics geriatrics pregnancy lactating...
Koppala RVS Chaitanya
 
Drug induced hematological disorder
Drug induced hematological disorderDrug induced hematological disorder
Drug induced hematological disorder
Chandrakant More
 
Pharmacotherapy of Malaria
Pharmacotherapy of MalariaPharmacotherapy of Malaria
Pharmacotherapy of Malaria
Koppala RVS Chaitanya
 
Pharmacotherapy of Tuberculosis
Pharmacotherapy of TuberculosisPharmacotherapy of Tuberculosis
Pharmacotherapy of Tuberculosis
Koppala RVS Chaitanya
 
Drug Therapy Monitoring
Drug Therapy MonitoringDrug Therapy Monitoring
Drug Therapy Monitoring
Dr. Ramesh Bhandari
 
Therapeutic drug monitoring
Therapeutic drug monitoringTherapeutic drug monitoring
Therapeutic drug monitoring
Urmila Aswar
 
Concepts of controlled and novel drug delivery system
Concepts of controlled and novel drug delivery systemConcepts of controlled and novel drug delivery system
Concepts of controlled and novel drug delivery system
Pratiksha Chandragirivar
 

What's hot (20)

Prescribing guidelines for pregnancy and lactation by Dr.Prudhvi
Prescribing guidelines for pregnancy and lactation by Dr.PrudhviPrescribing guidelines for pregnancy and lactation by Dr.Prudhvi
Prescribing guidelines for pregnancy and lactation by Dr.Prudhvi
 
Introduction to rational use of drugs and role of pharmacist in rational use...
Introduction to  rational use of drugs and role of pharmacist in rational use...Introduction to  rational use of drugs and role of pharmacist in rational use...
Introduction to rational use of drugs and role of pharmacist in rational use...
 
BASIC PRINCIPLES OF CANCER CHEMOTHERAPY- THIRD PHARM.D
BASIC PRINCIPLES OF CANCER CHEMOTHERAPY- THIRD PHARM.DBASIC PRINCIPLES OF CANCER CHEMOTHERAPY- THIRD PHARM.D
BASIC PRINCIPLES OF CANCER CHEMOTHERAPY- THIRD PHARM.D
 
General prescribing guidelines_for_pregnancy_and_breast_feeding
General prescribing guidelines_for_pregnancy_and_breast_feedingGeneral prescribing guidelines_for_pregnancy_and_breast_feeding
General prescribing guidelines_for_pregnancy_and_breast_feeding
 
Pharmacotherapy of renal failure
Pharmacotherapy of renal  failurePharmacotherapy of renal  failure
Pharmacotherapy of renal failure
 
Drug induced hematological disorders @rxvichu!!!
Drug induced hematological disorders @rxvichu!!!Drug induced hematological disorders @rxvichu!!!
Drug induced hematological disorders @rxvichu!!!
 
GENERAL PRESCRIBING GUIDELINES FOR PAEDIATRIC PATIENTS.pptx
GENERAL PRESCRIBING GUIDELINES FOR PAEDIATRIC PATIENTS.pptxGENERAL PRESCRIBING GUIDELINES FOR PAEDIATRIC PATIENTS.pptx
GENERAL PRESCRIBING GUIDELINES FOR PAEDIATRIC PATIENTS.pptx
 
Drug Induced Liver Disorder
Drug Induced Liver DisorderDrug Induced Liver Disorder
Drug Induced Liver Disorder
 
Drug Induced Renal Disease.pptx
Drug Induced Renal Disease.pptxDrug Induced Renal Disease.pptx
Drug Induced Renal Disease.pptx
 
Rheumatoid Arthritis - Pharmacotherapy
Rheumatoid Arthritis - Pharmacotherapy Rheumatoid Arthritis - Pharmacotherapy
Rheumatoid Arthritis - Pharmacotherapy
 
Drug Induced Pulmonary Diseases
Drug Induced Pulmonary DiseasesDrug Induced Pulmonary Diseases
Drug Induced Pulmonary Diseases
 
Drug induced renal failure By Shaista Sumayya
Drug induced renal failure By Shaista SumayyaDrug induced renal failure By Shaista Sumayya
Drug induced renal failure By Shaista Sumayya
 
Pharmacotherapy of Rheumatoid arthritis
Pharmacotherapy of Rheumatoid arthritisPharmacotherapy of Rheumatoid arthritis
Pharmacotherapy of Rheumatoid arthritis
 
General prescribing guidelines for Pediatrics geriatrics pregnancy lactating...
 General prescribing guidelines for Pediatrics geriatrics pregnancy lactating... General prescribing guidelines for Pediatrics geriatrics pregnancy lactating...
General prescribing guidelines for Pediatrics geriatrics pregnancy lactating...
 
Drug induced hematological disorder
Drug induced hematological disorderDrug induced hematological disorder
Drug induced hematological disorder
 
Pharmacotherapy of Malaria
Pharmacotherapy of MalariaPharmacotherapy of Malaria
Pharmacotherapy of Malaria
 
Pharmacotherapy of Tuberculosis
Pharmacotherapy of TuberculosisPharmacotherapy of Tuberculosis
Pharmacotherapy of Tuberculosis
 
Drug Therapy Monitoring
Drug Therapy MonitoringDrug Therapy Monitoring
Drug Therapy Monitoring
 
Therapeutic drug monitoring
Therapeutic drug monitoringTherapeutic drug monitoring
Therapeutic drug monitoring
 
Concepts of controlled and novel drug delivery system
Concepts of controlled and novel drug delivery systemConcepts of controlled and novel drug delivery system
Concepts of controlled and novel drug delivery system
 

Similar to Drug induced kidney disease

Hepatorenal syndrome
Hepatorenal syndromeHepatorenal syndrome
Hepatorenal syndromeAhad Lodhi
 
AKI.pptx
AKI.pptxAKI.pptx
AKI.pptx
AbebeGelaw
 
Eman anan- drugs -step- workshop-final 2
Eman anan- drugs -step- workshop-final 2Eman anan- drugs -step- workshop-final 2
Eman anan- drugs -step- workshop-final 2
FAARRAG
 
2.chronic glomerulonephritis
2.chronic glomerulonephritis2.chronic glomerulonephritis
2.chronic glomerulonephritis
AdhikariShila
 
AKI & CKD for DCM-converted.pdf
AKI & CKD for DCM-converted.pdfAKI & CKD for DCM-converted.pdf
AKI & CKD for DCM-converted.pdf
Aaron917801
 
Sindrome epatorenale
Sindrome epatorenaleSindrome epatorenale
Sindrome epatorenale
Roberto LEO, MD, FACP
 
Effect of Anesthesia and Surgery on Renal System.pptx
Effect of Anesthesia and Surgery on Renal System.pptxEffect of Anesthesia and Surgery on Renal System.pptx
Effect of Anesthesia and Surgery on Renal System.pptx
Ganta Ranganath
 
Chronic Kidney Disease -Dhaval Joshi
Chronic Kidney Disease -Dhaval JoshiChronic Kidney Disease -Dhaval Joshi
Chronic Kidney Disease -Dhaval Joshi
dhaval joshi
 
AKI.pptx
AKI.pptxAKI.pptx
AKI.pptx
musayansa
 
New uric acid disorder
New uric acid disorderNew uric acid disorder
New uric acid disorder
Dr. Lalit Agarwal
 
Uric acid disorders
Uric acid disordersUric acid disorders
Uric acid disorders
Dr. Lalit Agarwal
 
Capsules
CapsulesCapsules
Capsules
drsalwa22000
 
Drug induced nephrotoxicity
Drug induced nephrotoxicityDrug induced nephrotoxicity
Drug induced nephrotoxicity
saqibzaman11
 
Presentation (1).pptx medicine cirrhosis
Presentation (1).pptx medicine cirrhosisPresentation (1).pptx medicine cirrhosis
Presentation (1).pptx medicine cirrhosis
sarathrajum17
 
urological manifestation of diebetes mellitus
urological manifestation of diebetes mellitusurological manifestation of diebetes mellitus
urological manifestation of diebetes mellitus
dr vipin Drvipinsharma3
 
ANEMIA IN DIABETES MELLITUS
ANEMIA IN DIABETES MELLITUSANEMIA IN DIABETES MELLITUS
ANEMIA IN DIABETES MELLITUS
Naveen Kumar
 
Medication use in elderly
Medication use in elderlyMedication use in elderly
Medication use in elderly
Doha Rasheedy
 
hybara neprotic sydrome.ppt
hybara neprotic sydrome.ppthybara neprotic sydrome.ppt
hybara neprotic sydrome.ppt
victor431494
 
SLE- dhaval joshi
SLE- dhaval joshiSLE- dhaval joshi
SLE- dhaval joshi
dhaval joshi
 
Renal failure
Renal failureRenal failure
Renal failure
Hasan Ismail
 

Similar to Drug induced kidney disease (20)

Hepatorenal syndrome
Hepatorenal syndromeHepatorenal syndrome
Hepatorenal syndrome
 
AKI.pptx
AKI.pptxAKI.pptx
AKI.pptx
 
Eman anan- drugs -step- workshop-final 2
Eman anan- drugs -step- workshop-final 2Eman anan- drugs -step- workshop-final 2
Eman anan- drugs -step- workshop-final 2
 
2.chronic glomerulonephritis
2.chronic glomerulonephritis2.chronic glomerulonephritis
2.chronic glomerulonephritis
 
AKI & CKD for DCM-converted.pdf
AKI & CKD for DCM-converted.pdfAKI & CKD for DCM-converted.pdf
AKI & CKD for DCM-converted.pdf
 
Sindrome epatorenale
Sindrome epatorenaleSindrome epatorenale
Sindrome epatorenale
 
Effect of Anesthesia and Surgery on Renal System.pptx
Effect of Anesthesia and Surgery on Renal System.pptxEffect of Anesthesia and Surgery on Renal System.pptx
Effect of Anesthesia and Surgery on Renal System.pptx
 
Chronic Kidney Disease -Dhaval Joshi
Chronic Kidney Disease -Dhaval JoshiChronic Kidney Disease -Dhaval Joshi
Chronic Kidney Disease -Dhaval Joshi
 
AKI.pptx
AKI.pptxAKI.pptx
AKI.pptx
 
New uric acid disorder
New uric acid disorderNew uric acid disorder
New uric acid disorder
 
Uric acid disorders
Uric acid disordersUric acid disorders
Uric acid disorders
 
Capsules
CapsulesCapsules
Capsules
 
Drug induced nephrotoxicity
Drug induced nephrotoxicityDrug induced nephrotoxicity
Drug induced nephrotoxicity
 
Presentation (1).pptx medicine cirrhosis
Presentation (1).pptx medicine cirrhosisPresentation (1).pptx medicine cirrhosis
Presentation (1).pptx medicine cirrhosis
 
urological manifestation of diebetes mellitus
urological manifestation of diebetes mellitusurological manifestation of diebetes mellitus
urological manifestation of diebetes mellitus
 
ANEMIA IN DIABETES MELLITUS
ANEMIA IN DIABETES MELLITUSANEMIA IN DIABETES MELLITUS
ANEMIA IN DIABETES MELLITUS
 
Medication use in elderly
Medication use in elderlyMedication use in elderly
Medication use in elderly
 
hybara neprotic sydrome.ppt
hybara neprotic sydrome.ppthybara neprotic sydrome.ppt
hybara neprotic sydrome.ppt
 
SLE- dhaval joshi
SLE- dhaval joshiSLE- dhaval joshi
SLE- dhaval joshi
 
Renal failure
Renal failureRenal failure
Renal failure
 

More from swathisravani

Syphilis
SyphilisSyphilis
Syphilis
swathisravani
 
Chemotherapy induced nausea and vomiting
Chemotherapy induced nausea and vomitingChemotherapy induced nausea and vomiting
Chemotherapy induced nausea and vomiting
swathisravani
 
Leukaemia
LeukaemiaLeukaemia
Leukaemia
swathisravani
 
Breast cancer
Breast cancerBreast cancer
Breast cancer
swathisravani
 
Chemotherapy agents
Chemotherapy agentsChemotherapy agents
Chemotherapy agents
swathisravani
 
Basic principles of cancer chemotherapy
Basic principles of cancer chemotherapyBasic principles of cancer chemotherapy
Basic principles of cancer chemotherapy
swathisravani
 
Scabies
ScabiesScabies
Scabies
swathisravani
 
Impetigo
ImpetigoImpetigo
Impetigo
swathisravani
 
Eczema or Dermatitis
Eczema or DermatitisEczema or Dermatitis
Eczema or Dermatitis
swathisravani
 
Psoriasis
PsoriasisPsoriasis
Psoriasis
swathisravani
 
Chronic Renal Failure
Chronic Renal FailureChronic Renal Failure
Chronic Renal Failure
swathisravani
 
Acute Renal Failure
Acute Renal FailureAcute Renal Failure
Acute Renal Failure
swathisravani
 
SYSTEMIC LUPUS ERYTHEMATOSUS
SYSTEMIC LUPUS ERYTHEMATOSUSSYSTEMIC LUPUS ERYTHEMATOSUS
SYSTEMIC LUPUS ERYTHEMATOSUS
swathisravani
 
Ankylosing Spondylitits
Ankylosing SpondylititsAnkylosing Spondylitits
Ankylosing Spondylitits
swathisravani
 
Gout
GoutGout
Osteoarthritis
OsteoarthritisOsteoarthritis
Osteoarthritis
swathisravani
 
Rheumatoid arthritis
Rheumatoid arthritisRheumatoid arthritis
Rheumatoid arthritis
swathisravani
 
Viral hepatitis
Viral hepatitisViral hepatitis
Viral hepatitis
swathisravani
 
Gonorrhea
GonorrheaGonorrhea
Gonorrhea
swathisravani
 
Malaria
MalariaMalaria
Malaria
swathisravani
 

More from swathisravani (20)

Syphilis
SyphilisSyphilis
Syphilis
 
Chemotherapy induced nausea and vomiting
Chemotherapy induced nausea and vomitingChemotherapy induced nausea and vomiting
Chemotherapy induced nausea and vomiting
 
Leukaemia
LeukaemiaLeukaemia
Leukaemia
 
Breast cancer
Breast cancerBreast cancer
Breast cancer
 
Chemotherapy agents
Chemotherapy agentsChemotherapy agents
Chemotherapy agents
 
Basic principles of cancer chemotherapy
Basic principles of cancer chemotherapyBasic principles of cancer chemotherapy
Basic principles of cancer chemotherapy
 
Scabies
ScabiesScabies
Scabies
 
Impetigo
ImpetigoImpetigo
Impetigo
 
Eczema or Dermatitis
Eczema or DermatitisEczema or Dermatitis
Eczema or Dermatitis
 
Psoriasis
PsoriasisPsoriasis
Psoriasis
 
Chronic Renal Failure
Chronic Renal FailureChronic Renal Failure
Chronic Renal Failure
 
Acute Renal Failure
Acute Renal FailureAcute Renal Failure
Acute Renal Failure
 
SYSTEMIC LUPUS ERYTHEMATOSUS
SYSTEMIC LUPUS ERYTHEMATOSUSSYSTEMIC LUPUS ERYTHEMATOSUS
SYSTEMIC LUPUS ERYTHEMATOSUS
 
Ankylosing Spondylitits
Ankylosing SpondylititsAnkylosing Spondylitits
Ankylosing Spondylitits
 
Gout
GoutGout
Gout
 
Osteoarthritis
OsteoarthritisOsteoarthritis
Osteoarthritis
 
Rheumatoid arthritis
Rheumatoid arthritisRheumatoid arthritis
Rheumatoid arthritis
 
Viral hepatitis
Viral hepatitisViral hepatitis
Viral hepatitis
 
Gonorrhea
GonorrheaGonorrhea
Gonorrhea
 
Malaria
MalariaMalaria
Malaria
 

Recently uploaded

Physiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of TastePhysiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of Taste
MedicoseAcademics
 
THOA 2.ppt Human Organ Transplantation Act
THOA 2.ppt Human Organ Transplantation ActTHOA 2.ppt Human Organ Transplantation Act
THOA 2.ppt Human Organ Transplantation Act
DrSathishMS1
 
Charaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyaya
Charaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyayaCharaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyaya
Charaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyaya
Dr KHALID B.M
 
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
The hemodynamic and autonomic determinants of elevated blood pressure in obes...The hemodynamic and autonomic determinants of elevated blood pressure in obes...
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
Catherine Liao
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
addon Scans
 
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfMANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
Jim Jacob Roy
 
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Savita Shen $i11
 
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.GawadHemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
NephroTube - Dr.Gawad
 
Prix Galien International 2024 Forum Program
Prix Galien International 2024 Forum ProgramPrix Galien International 2024 Forum Program
Prix Galien International 2024 Forum Program
Levi Shapiro
 
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdfARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
Anujkumaranit
 
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
Swetaba Besh
 
basicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdfbasicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdf
aljamhori teaching hospital
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
Dr. Rabia Inam Gandapore
 
Are There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdfAre There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdf
Little Cross Family Clinic
 
The Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of IIThe Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of II
MedicoseAcademics
 
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness JourneyTom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
greendigital
 
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #GirlsFor Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
Savita Shen $i11
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
VarunMahajani
 
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
kevinkariuki227
 

Recently uploaded (20)

Physiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of TastePhysiology of Special Chemical Sensation of Taste
Physiology of Special Chemical Sensation of Taste
 
THOA 2.ppt Human Organ Transplantation Act
THOA 2.ppt Human Organ Transplantation ActTHOA 2.ppt Human Organ Transplantation Act
THOA 2.ppt Human Organ Transplantation Act
 
Charaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyaya
Charaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyayaCharaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyaya
Charaka Samhita Sutra Sthana 9 Chapter khuddakachatuspadadhyaya
 
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
The hemodynamic and autonomic determinants of elevated blood pressure in obes...The hemodynamic and autonomic determinants of elevated blood pressure in obes...
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
 
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfMANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
 
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
 
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.GawadHemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
 
Prix Galien International 2024 Forum Program
Prix Galien International 2024 Forum ProgramPrix Galien International 2024 Forum Program
Prix Galien International 2024 Forum Program
 
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdfARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
 
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF URINARY SYSTEM.pptx
 
basicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdfbasicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdf
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
 
Are There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdfAre There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdf
 
The Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of IIThe Normal Electrocardiogram - Part I of II
The Normal Electrocardiogram - Part I of II
 
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness JourneyTom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
 
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #GirlsFor Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
 
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptxMaxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
 
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
 
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
 

Drug induced kidney disease

  • 1. Drug induced kidney disease Dr. V. S. Swathi Assistant Professor 1
  • 2. Definition It is defined as abrupt or gradual loss of renal function due to drugs and is characterised by increased serum creatinine value and blood urea nitrogen which is having temporal relationship between renal toxicity and drug 2
  • 3. Epidemiology • Acute tubular necrosis is most common cause of drug induced kidney disease in hospitalised patients • Mostly this problem is reversible with discontinuation of offending agent but sometimes it is irreversible even after withdrawl of drug • In adults, it is approximately 14-26% in prospective studies of acute kidney injury • In paediatric population, it is responsible for 16% of drug induced Acute kidney injury which leads to hospitalisation • In India, it leads to 20% of total acute kidney injury cases 3
  • 4. Risk factors • Increased age • Alcohol abuse • Pre existing kidney disease • Critically ill patients • Large total cumulative dose of drugs • Prolonged therapy of nephrotoxic drugs • Concomitant therapy of 2 or more nephrotoxic drugs • Diabetes • Poor nutrition • Shock • Liver diseases • Dehydration • Hypotension • Cardiovascular diseases • Administration of contrast media 4
  • 5. Causes Tubular epithelial cell damage • Acute tubular necrosis • Aminoglycosides • Amphotericin B • Antiviral drugs • Anticancer drugs • Radiographic contrast media Osmotic nephrosis • Mannitol • Sucrose • IV immunoglobulin 5
  • 6. Causes continued…. Hemodynamically mediated kidney injury • Angiotensin converting enzyme inhibitors • Angiotensin receptor blockers • Non steroidal anti inflammatory drugs 6
  • 7. Causes continued…. Obstructive nephropathy Crystal nephropathy • Anti viral drugs • Sulphonamides • Methotrexate Nephrolithiasis • Sulphonamides Nephrocalcinosis • Oral sodium phosphate solution 7
  • 8. Causes continued…. Glomerular disease Minimal change disease • Non steroidal anti inflammatory drugs • Lithium Focal segmental Glomerulosclerosis • Interferon alpha and beta • Anabolic steroids Membranous disease • Non steroidal anti inflammatory drugs • Captopril 8
  • 9. Causes continued…. Tubulointerstitial disease Acute allergic interstitial nephritis • Pencillins • Ciprofloxacin • Non steroidal anti inflammatory drugs • Proton pump inhibitors • Loop diuretics Chronic interstitial nephritis • Lithium • Cyclosporine Papillary necrosis • Non steroidal anti inflammatory drugs • Aspirin • Caffeine 9
  • 10. Causes continued…. Renal Vasculitis, thrombosis and cholesterol emboli Vasculitis and Thrombosis • Allopurinol • Propylthiouracil Cholesterol emboli • Warfarin • Thrombolytic agents 10
  • 17. 17
  • 18. 18
  • 19. Clinical presentation • Decrease in glomerular filtration rate • Increase in serum creatinine and blood urea nitrogen • Malaise • Anorexia • Vomiting • Oedema • Shortness of breath • Decreased urine output • Metabolic acidosis with bicarbonaturia • Glycosuria • Polyuria • Hyperkaelemia 19
  • 20. Complications • Tubulopathies • Nephrotic syndrome • Acute kidney disease • Chronic kidney disease 20
  • 21. Diagnosis • Medical and medication history • Clinical presentation • Renal function tests • Electrolyte levels • Urine microscopy • Creatinine clearance • CT scan of kidney and urinary tract • MRI of kidney and urinary tract • Kidney biopsy 21
  • 22. Prevention and Treatment • Know about potentially nephrotoxic drugs • Identify high risk groups of patients • Avoid use of nephrotoxic drugs in high risk groups • Avoid use of combination of 2 or more nephrotoxic drugs • Adjust dose and duration of nephrotoxic drugs • Maintain adequate hydration while using nephrotoxic drugs • In severe cases of DIKD cases, go for renal replacement therapy 22
  • 24. Resources • https://bmcnephrol.biomedcentral.com/track/pdf/10.1186/ s12882-017-0536-3 • https://cjasn.asnjournals.org/content/clinjasn/13/12/1897.f ull.pdf • file:///E:/TEST%20BOOK/DIKD%20ARTICLE.pdf • https://sci-hub.tw/10.2174/1389200218666171108154419 • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3794522/p df/ooomb4-20-268.pdf 24