Intrinsic Renal Disease: Meds/Drugs

Etiology

  • Acute Interstitial Nephritis (AIN): abx, NSAIDs, other
  • ATN/Direct toxicity: aminoglycocides, contrast, many others
  • Crystal nephropathy: ampicillin, cipro, acyclovir, others
  • Rhabdomyolysis (w/tubular toxicity): haldol, others
  • Thrombotic angiopathy (TTP): quinine, others
  • Worth noting that Meds can cause renal toxicity via multiple paths. e.g. NSAIDs can cause Interstitial neprhritis and contribute to pre-renal injury (decreased PGs--> decreased afferent dilation, in particular if hypovolemic)

Risk Factors

  • Chronic kidney disease
  • Hypovolemia and/or hypo-perfusion
  • Exposure to multiple toxins at same time
  • Age > 60, DM, CHF, concurrent severe illness (e.g. sepsis)

Symptoms

  • Decreased urine output, fatigue, SOB (volume overload)
  • Symptoms vary significantly - sometimes only detected on lab testing

Physical Exam Findings

  • Sometimes tachycardia, hypotension, hypoxemia --> varies based on degree of AKI, other co-existent problems
  • Sometime volume over load
  • Some skin eruption with AIN