What are the dosing recommendations and indications for use of bisphosphonates in states of kidney injury? In general, most of the data for the use of bisphosphonates in patients with varying degrees of Acute Kidney Injruy have come from trials looking at treatment of hypercalcemia associated with multiple myeloma and other malignancies. Metabolic changes in …
What is the association between proton pump inhibitors and acute interstitial nephritis? The PPIs (i.e., omeprazole and lansoprazole) are fast becoming one of the most common causes of drug-induced AIN. The first documented case was in 1992. Since then, numerous case series with biopsy-proven disease have been published. The interaction appears to be a class …
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How can ACE inhibitors and ARBS cause kidney dysfunction while being protective in diabetic nephropathy? ACE inhibitors and ARBs exert their effects by blocking the RAAS pathway. The pharmacodynamic effects of these agents are achieved by inhibiting the vasoconstrictive effect of angiotensin II at the efferent arteriole in the glomerulus. RAAS blockade at the glomerular …
What drugs have been associated with or precipitate nephrolithiasis? Several agents can crystallize in the urine, such as indinavir, topirmate, acyclovir, sulfadiazine, and triamterene. Stones related to these drugs usually involve the crystalline structure. Topirmate is a carbonic anhydrase inhibitor and causes systemic metabolic acidosis, which leads to decreased urinary citrate excretion. Alternation of urinary …
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What are the common risk factors for aminoglycoside kidney toxicity? Dose and duration of therapy, advanced age, use of other nephrotoxic agents (cyclosporine, tacrolimus, vancomycin), sepsis, hypotension, dehydration, and intravenous radiologic contrast medium have been reported as important risk factors in the development of aminoglycoside-induced nephrotoxicity. However, when confounding factors are adjusted using multivariate analysis, …
What are the common drug interactions for cyclosporine and tacrolimus in kidney transplant recipients Many drugs are known to interact with CNIs (cyclosporine and tacrolimus); some agents are more problematic than others. Antiepileptic medications such as phenytoin, carbamazepine, and phenobarbital; antituberculosis agents such as rifampin, rifabutin, and isoniazid (INH); and herbal supplements such as St. …
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How is dosage of anticonvulsants adjusted in CKD? Phenytoin is a highly protein-bound drug. In patients receiving dialysis or in patients with CKD and significant proteinuria, the free fraction of phenytoin (free phenytoin) is elevated, although plasma phenytoin levels seem low. If not adjusted, total phenytoin levels are of little value. In patients receiving dialysis, …
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