Welcome to Scribd. Sign in or start your free trial to enjoy unlimited e-books, audiobooks & documents.Find out more
Download
Standard view
Full view
of .
Look up keyword
Like this
2Activity
0 of .
Results for:
No results containing your search query
P. 1
Kidney Diseases - VOLUME ONE - Chapter 11

Kidney Diseases - VOLUME ONE - Chapter 11

Ratings:

5.0

(1)
|Views: 174|Likes:
Published by Firoz Reza
Chapters are from VOL 1 of Atlas of Kidney Diseases. There are more 4 VOLUME. To get other VOLUME log on to http://www.kidneyatlas.org
Chapters are from VOL 1 of Atlas of Kidney Diseases. There are more 4 VOLUME. To get other VOLUME log on to http://www.kidneyatlas.org

More info:

Categories:Types, School Work
Published by: Firoz Reza on Feb 24, 2009
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF or read online from Scribd
See more
See less

01/29/2013

 
11
Renal Injury Due ToEnvironmental Toxins,Drugs, and Contrast Agents
T
he kidneys are susceptible to toxic or ischemic injury for sever-al reasons. Thus, it is not surprising that an impressive list of exogenous drugs and chemicals can cause clinical acute renalfailure (ARF) [1]. On the contrary, the contribution of environmentaltoxins to ARF is rather limited. In this chapter, some of the most com-mon drugs and exogenous toxins encountered by the nephrologist inclinical practice are discussed in detail.The clinical expression of the nephrotoxicity of drugs and chemi-cals is highly variable and is influenced by several factors. Amongthese is the direct toxic effect of drugs and chemicals on a particulartype of nephron cell, the pharmacologic activity of some substancesand their effects on renal function, the high metabolic activity (
ie
, vul-nerability) of particular segments of the nephron, the multiple trans-port systems, which can result in intracellular accumulation of drugsand chemicals, and the high intratubule concentrations with possibleprecipitation and crystallization of particular drugs.
Marc E. De Broe 
C H A PT ER
 
11.2
Acute Renal Failure
FIGURE 11-1
Sites of renal damage, including factors thatcontribute to the kidney’s susceptibility todamage. ACE—angiotensin-convertingenzyme; NSAID—nonsteroidal anti-inflam-matory drugs; HgCl
2
—mercuric chloride.
General Nephrotoxic Factors
The nephron
CortexOuterstripeInnerstripe
   O  u   t  e  r  m  e   d  u   l   l  a
Innermedula
                                M                       e                                d                        u                                 l                                l                       a                        r                       y                                r                       a                        y         
Sites of renal damageACEinhibitorsNSAIDsAcyclovirCisplatinumHgCl2LithiumIschemiaAminoglycosidesVulnerability of the kidneyImportant blood flow (1/4 cardiac output)High metabolic activityLargest endothelial surface by weightMultiple enzyme systemsTranscellular transportConcentration of substancesProtein unbindingHigh O2 consumption/delivery ratioin outer medullaS
1
S
1
S
2
S
2
S
3
S
3
 
11.3
Renal Injury Due To Environmental Toxins, Drugs, and Contrast Agents
DRUGSAND CHEMICALSASSOCIATED WITH ACUTE RENAL FAILURE
MechanismsM1 Reduction in renal perfusion through alteration of intrarenal hemodynamicsM2 Direct tubular toxicityM3 Heme pigment–induced toxicity (rhabdomyolysis)M4 Intratubular obstruction by precipitation of the agents or its metabolites or byproductsM5 Allergic interstitial nephritisM6 Hemolytic-uremic syndrome
M1
M2
M3
M4
M5*
M6
Drugs
Cyclosporine, tacrolimusAmphotericin B, radiocontrast agentsNonsteroidal anti-inflammatory drugsAngiotensin-converting enzyme inhibitors, interleukin-2
Methotrexate
§
Aminoglycosides, cisplatin, foscarnet, heavy metals, intravenous immunoglobulin
, organic solvents, pentamidineCocaineEthanol, lovastatin**SulfonamidesAcyclovir, Indinavir, chemotherapeutic agents, ethylene glycol***Allopurinol, cephalosporins, cimetidine, ciprofloxacin, furosemide, penicillins, phenytoin, rifampin, thiazide diureticsConjugated estrogens, mitomycin, quinine* Many other drugs in addition to the ones listed can cause renal failure by this mechanism.
Interleukin-2 produces a capillary leak syndrome with volume contractions.
§
Uric acid crystals form as a result of tumor lysis.
The mechanism of this agent is unclear but may be due to additives.** Acute renal failure is most likely to occur when lovastatin is given in combination with cyclosporine.*** Ethylene glycol–induced toxicity can cause calcium oxalate crystals.
FIGURE 11-2
Drugs and chemicals associated with acute renal failure. (
 Apapted from
Thadhani,
et al.
[2].)

Activity (2)

You've already reviewed this. Edit your review.
1 thousand reads
1 hundred reads

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->