NEFROTOXICIDAD

HOSPITAL GENERAL AGUSTIN O’HORAN

MEDICINA INTERNA
DR VIRGILIO MELGAR MANZANILLA R1
 NEFROTOXICIDAD
• SE DEFINE COMO UNA ENFERMEDAD O
DISFUNCION RENAL AQUE SUSCEDE COMO
CONSECUENCIA DE UNA EXPOSICION
DIRECTA O INDIRECTA A MEDICAMENTOS, Y
SUSTANCIAS QUIMICAS INDUSTRIALES O
AMBIENTALES .
 SUSEPTIBILIDAD RENAL
• El corazón recibe 25% del gasto cardiaco en
reposo (3.5ml/g/min).
• La rama ascendente gruesa del asa de Henle
es el área metabólicamente mas activa del
riñón y con el flujo sanguíneo mas limitado.
 Factors of renal function that increase
suseptibility
• Renal blood flow 25% of resting cardiac output (3.5ml/g/min).
• Thick ascending limb is the most suseptible for its high metabolic
rate and limited blood flow.
• Largest endothilial surface by weight
• Highest capillar hydrostatic presure: contribute to trapping of
circulating antigen.
• Is the only place where highly protien bound drugs are unbound and
can concentrate in the proximal tuble.
• In the distal part of the nephron urine is concentrated and the
liklyhood of crystalline precipitation increases.
• During renal excretion drugs may undergo bioactivation to reactive
metabolites.
• Reduction in renal perfusion through
alteration of intrarenal hemodynamics.
• Acute tubular necrosis
• Acute interstial nephritis
• Tubular obstruction
• Hem-pigment induced toxicity
• Thrombotico microangiopathy (HUS)
 Mecanismos de Nefrotoxicidad
• DIRECTO:
– NECROSIS TUBULAR AGUDA
– NEFRITIS INTERSTICIAL
– TOXICA
– OBSTRUCCION TUBULAR

• INDIRECTO:
– ALTERACIONES HEMODINAMICAS
– MICROANGIOPATIA
 NECROSIS TUBULAR AGUDA
• Aminoglucósidos

• Amfotericina

• Cisplatino

• Inducido por contraste