The kidneys excrete waste, remove excess fluid, balance electrolytes, stabilize blood pressure and have an effect on red blood cell production. Vital to survival, the kidneys face daily toxin exposure. Toxins can originate from from chemicals, infections and medications. When it comes to medications, physicians must consider the benefit-to-risk ratio when prescribing nephrotoxic drugs. To prevent kidney damage, people should be aware of what medications can cause renal failure.
Aminoglycosides
Gentamicin and streptomycin are examples of aminoglycosides. These broad-spectrum antibiotics stop protein synthesis, a vital process of bacterial cell division and growth. Primarily used intravenously to treat life-threatening systemic infections of the respiratory tract, gastrointestinal system and heart, aminoglycosides can damage the filtering units of the kidneys. Protein in the urine is a sign of damage, and patients require continuous assessment of kidney function while receiving this drug.
Glycopeptides
This class of antibiotic is used frequently in the hospital setting. Vancomycin is an example of a glycopeptide antibiotic. Like the aminoglycosides, vancomycin is used to treat systemic infections that are resistant to other medications, and it can cause kidney failure.
Amphotericin B
Amphotericin B is an antifungal medication used intravenously to eliminate potentially fatal systemic fungal infections. The authors of "Pearson Nurse's Drug Guide 2010" report that amphotericin B can cause life-threatening nephrotoxicity. Patients receiving amphotericin B need close monitoring for decreased urine output, cloudy or pink urine and fluid retention, all signs of kidney damage. Symptoms must be caught early to prevent permanent kidney failure.
Cisplatin
A heavy metal complex containing platinum used to treat cancer, cisplatin is used in combination with other antineoplastic medications to treat reproductive cancers. Used alone, cisplatin can damage the kidney; used in conjunction with other nephrotoxic medications, the chance of renal failure increases.
Cyclosporine
Cyclosporine is an immunosuppressant used to prevent organ rejection in transplant patients. Ironically, renal transplant patients receive cyclosporine and face a high risk of kidney damage. Transplant patients undergo continuous kidney function assessment to detect early signs of kidney failure.
Foscarnet
This antiviral drug frequently causes nephrotoxicity that can be life threatening. Patients receive foscarnet to treat cytomegalovirus, herpes simplex virus, Epstein-Barr virus and varicella-zoster virus.
Non-Steroidal Anti-Inflammatory Drugs
The National Kidney Foundation Clinical Practice Guidelines establish safe dosing parameters for non-steroidal anti-inflammatory drugs. The general public consumes these medications in large quantity. Ibuprofen and naproxen are two examples of commonly used NSAIDS that are available over the counter; chronic use and taking dosages that are higher than the recommended dose can cause renal failure.
Pentamidine
Pentamidine isethionate can cause acute renal failure. Used to treat such infections as Pneumocystis carinii pneumonia, symptoms of renal failure appear quickly and require urgent intervention.
Radiographic Contrast Media
Many hospital diagnostic tests require the use of radiographic contrast media. For example, an intravenous pyelogram to examine the kidneys and structures of the urinary system uses contrast dye that can damage the kidneys, especially in patients with underlying kidney function impairment. Patients should have baseline kidney function assessed prior to undergoing such procedures.
References
- "Pearson Nurse's Drug Guide 2010"; Billie A. Wilson et al.; 2010
- National Kidney Foundation: Clinical Practice Guidelines and Clinical Practice Recommendations 2006
- "Medical-Surgical Nursing: Critical Thinking for Collaborative Care"; Donna D. Ignatavicius et al.; 2006
