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Drugs and The Kidney

 

Can drugs harm my kidneys?

There are some drugs that can potentially harm the kidneys. Not all drugs are harmful to the kidneys in a direct manner. Acute kidney injury generally occurs with chronic use of certain drugs. Ask your doctor or pharmacist about the potential for kidney injury if you are taking a new drug.

Diagram 1 : Normal Kidney vs Disease Kidney

What are the drugs that can harm my kidneys?

There are many types of drugs that can harm the kidneys.  These drugs can be Over-The-Counter (OTC) products, controlled medicines or drugs of abuse.

Common OTC products reported to cause varying degree of harm to the kidneys especially if taken in large amounts:

  • Aspirin
  • Paracetamol

Common controlled medicines:

1. Analgesics or Pain-killers: mefenamic acid, diclofenac, ibuprofen, indomethacin, naproxen, celecoxib, etoricoxib

  • None of these medicines should be taken daily or regularly without first talking to your doctor or pharmacist.

2. Antibiotics & antivirals: aminoglycoside, vancomycin, acyclovir, ganciclovir

  • Antibiotics can also be dangerous if they are not taken correctly. People with kidney disease need to take a smaller amount of antibiotics than people with healthy kidneys. Take only medicines ordered for you by your doctor.

3. Antidepressants : fluoxetine, amitryptilline

4. Antigout: Allopurinol

5. Blood pressure medicines: ACE inhibitors (eg. Perindopril, enalapril, captopril etc) and angiotensin receptor blockers (ARBs) (losartan, valsartan, telmisartan etc)

6. Diuretics: frusemide

7. Ulcer medicine: cimetidine

Traditional drugs:

  • Chinese herbals which contains aristocholic acid

Drugs of abuse:

  • Cocaine
  • Heroine
  • Ketamine
  • Metamphetamine

Agents used in medical imaging tests eg. Angiography or CT scans

  • Contrast dye

Apart from these drugs, there are many unregistered products which are sold by the streets that are found to be adulterated with harmful substances.

Whose kidneys are very prone to be harmed by drugs?

Drugs causing kidney injury tends to be more common among certain patients and specific clinical conditions.

Patients at highest risk of drug-induced nephrotoxicity are those with one or more of the following:

  • age older than 60 years
  • underlying renal insufficiency (e.g., GFR < 60 mL per minute per 1.73 m2)
  • dehydrated
  • multiple exposures to other agents that are toxic to the kidneys
  • diabetes
  • heart failure
  • blood infection

What can i do to prevent drugs from harming my kidneys?

Acute kidney injury (AKI) is often difficult to predict or prevent. But you may reduce your risk by taking care of your kidneys. Try to:

  • Follow instructions on medications. Follow the instructions on OTC pain medications such as aspirin, paracetamol (Panadol, others) ibuprofen (Nurofen, others). Taking excessive doses may increase your risk of acute kidney injury. This is especially true if you have pre-existing kidney disease, diabetes or high blood pressure.
  • Work with your doctor to manage kidney problems. If you have kidney disease or other diseases or conditions that increase your risk of acute kidney injury, such as diabetes or high blood pressure, follow your doctor’s recommendations for managing your condition.
  • Make a healthy lifestyle a priority. Be active; eat a sensible, balanced diet; and drink alcohol only in moderation — if at all.
  • DO NOT take recreational drugs that harm the general health eg. cocaine, heroine, methamphetamines. These drugs are commonly known to cause direct harm to the kidneys.
  • Correcting risk factors if possible eg. Keeping well hydrated before starting a treatment.
  • Do not take any medicine, drug or substance unless you are under a doctor’s supervision.
  • Do not take pills or substances given to you by a stranger or even a friend.
  • If you do take a medication or other substance and feel ill, contact your doctor immediately.
  • Bring the suspected drug and all other concurrent drugs that you are taking to the doctor to help the assessment of your condition.

Can i recover if I develop kidney dysfunction cause by certain drugs?

It is possible to recover from acute kidney injury which was caused by drugs if:

  • Prompt assessment by a doctor and appropriate treatment were sought after.
  • Quickly stopping the offending drug after consulting a doctor or pharmacist.

On the other hand, there are times when constant and high usage of a drug leads to chronic kidney disease when full recovery of the kidney function is no longer possible.

 

Reference

  1. Naughton, C.A (2008). Drug induced nephrotoxicity. Am Fam Physician, 78(6):743-750.
  2. https://www.mayoclinic.org

 

Semakan Akhir : 06 November 2017
Penulis : Manjulaa Devi Subramaniam
Akreditor : Ng Ru Shing

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