Drug-induced Acute Renal Failure

Drug-induced Acute Renal Failure is a serious kidney disease which may threaten the patient's life. Usually, this condition has something to do with individual's physical condition or dosage and course of the treatment. Patients may have or have had some risk factors before the onset of drug-induced Acute Renal Failure; if the patients start to take some nephrotoxic medications at that time, Acute Renal Failure will be induced.
Clinical prevention of Drug-induced Acute Renal Failure focuses on the following:
1. Ask details about medical history and allergic medicines of the patients before giving medicines and avoid application of allergic medicines.
2. Avoid application of nephrotoxic drugs in combination, for instance, combination of cephalosporin and aminoglycoside. In addition, aminoglycoside is not suggested to use together with diuretics.
3. Using nephrotoxic drugs cautiously, especially to elderly, children, diabetic patients, hypertensive patients and patients with high blood viscosity or with hypovolemia. These people are high risk groups of Drug-induced Acute Renal Failure. Enough Fluid supplements should be given to dehydrated people before administering nephrotoxic drugs. For patient with Heart Failure or hepatic disease, the dosage of nephrotoxic drugs should be controlled strictly because such patients may have impaired renal perfusion and decreased detoxification respectively. If the patients already have kidney disease, non-steroidal anti-inflammatory drugs needs to be avoided as possible. Even for health people, nephrotoxic drugs should be applied correctly.
4. There are some medicines easy to form crystals in urine; to stave off obstruction of renal tubules, patients should be given rehydration therapy and other treatments to alkalize urine when administer the medicine.
5. Allopurinol needs to be administered before tumor chemotherapy to decrease formation of uric acid.
6. Kidney derived hemorrhage can not be treated by 6-aminocaproic acid because 6-aminocaproic acid may cause blood clot in the ureters. When 6-aminoproic acid is administered for treating other hemorrhage, the patient should be closely observed.
7. Nephrotoxicity of Contrast medium is just after amino glycosides. Large dosage of contrast medium or repeated imaging may aggravate or lead patient to dehydration, decreased renal perfusion, kidney damage, Diabetes, Hypertension or multiple myeloma; thus people with above health problems should avoid contrast examinations as possible as they can.
8. Adequate fluid should be given before and during chemotherapy to decrease the morbidity of nephrotoxicity.
9. Monitoring drug concentration in blood plasma may be necessary. For example, when concentration of Gentamicin in blood plasma is greater than 12mg/L, nephrotoxicity will increase. Monitoring drug concentration in blood plasma can adjust dosage of medicine on time and avoid Drug-induced Acute Renal Failure.
10. There are some medications possibly to cause Acute Renal Failure; therefore frequently monitoring levels of urine lysozyme and B2-microglobulin are necessary. These indicators facilitate detection of renal tubules damage. In addition, if the patients are taking ACEI, regular check ups of blood urea nitrogen (BUN), serum creatinine and GFR should be done to avoid Drug-induced Acute Renal Failure.
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