As the body's blood filtering system, the kidneys bear a high level of exposure to circulating medications. Decreased blood flow to the kidneys, direct damage to kidney cells and inflammatory-mediated damage may culminate in kidney failure. Diverse medications can precipitate kidney failure, ranging from over-the-counter pain relievers to potent antibiotics. In some cases, withdrawal of the offending medication permits restoration of normal kidney function; other medication-induced kidney damage proves permanent.
Aminoglycoside Antibiotics
Aminoglycoside antibiotics commonly cause kidney damage and acute renal failure. In a review article entitled, "Aminoglycosides: Nephrotoxicity" published in the journal "Antimicrobial Agents and Chemotherapy," Drs. Marie-Paule Mingeot-Leclercq and Paul Tulkens explain that certain kidney cells absorb aminoglycosides during the blood filtration process. Once inside the cells, the drugs have deleterious effects on cellular metabolism, potentially leading to kidney cell death. Commonly prescribed aminoglycosides include amikacin, gentamicin, kanamycin, neomycin, streptomycin and tobramycin. According to Mingeot-Leclercq and Tulkens, kidney function recovers to pretreatment levels in most patients several weeks after discontinuation of the offending aminoglycoside antibiotic.
Angiotensin Converting Enzyme Inhibitors
Angiotensin converting enzyme inhibitors, more commonly known as ACE inhibitors, are frequently prescribed for the treatment of high blood pressure. These medications cause relaxation of the arteries, thereby reducing blood pressure. As Dr. Cynthia Naughton explains in a 2008 article published in "American Family Physician," decreased arterial pressure and the associated reduction in blood flow to the kidneys may be sufficient to trigger acute renal failure. Risk factors that may contribute to the development of ACE inhibitor-associated kidney failure include dehydration, advancing age, underlying kidney disease, and use of nonsteroidal anti-inflammatory medications, tacrolimus, cyclosporine, or adrenergic receptor binder medicines. Commonly prescribed ACE inhibitors include benazepril, captopril, enalapril, lisinopril, moexipril and trandolapril.
Nonsteroidal Anti-Inflammatory Drugs
Nonsteroidal anti-inflammatory drugs, also known as NSAIDs, may precipitate acute or chronic renal failure. NSAIDs inhibit the cyclooxygenase or COX enzymes, causing decreased production of chemicals called prostaglandins. Decreased kidney blood flow results from the suppression of prostaglandin production. Similar to the effect of ACE inhibitors, decreased renal blood flow may precipitate acute renal failure among at-risk individuals. The National Institute of Diabetes and Digestive and Kidney Diseases states that NSAID-related acute renal failure is usually reversible with discontinuation of the offending medication.
Protracted use of NSAIDs over a period of years can lead to a form of chronic renal failure termed analgesic nephropathy. Chronic inflammation in the kidneys causes slowly progressive damage with concomitantly decreased function. "The Merck Manual for Healthcare Professionals" notes that discontinuation of NSAID medications usually arrests further disease progression. Commonly used over-the-counter and prescription NSAIDs include ibuprofen, ketoprofen, meloxicam, nabumetone, naproxen, piroxicam and sulindac.
References
- "Antimicrobial Agents and Chemotherapy"; Aminoglycosides--Nephrotoxicity; Marie-Paule Mingeot-Leclercq, Paul M. Tulkens; May 1999
- "Canadian Family Physician"; Nephrotoxic Drugs; Tom Hewlett, M.D.; May 2004
- "American Family Physician"; Drug-Induced Nephrotoxicity; Cynthia A. Naughton, Pharm.D.; September 2008
- "British Journal of Clinical Pharmacology"; Glomerular, Tubular and Interstitial Nephritis Associated with Non-Steroidal Antiinflammatory Drugs; Uffe Ravnskov; February 1999
- National Institute of Diabetes and Digestive and Kidney Diseases: Analgesic Nephropathy (Painkillers and the Kidneys)
