The National Kidney Foundation states that drugs can cause kidney problems. Abuse of street drugs like heroin and crack and misuse of over-the-counter analgesics can permanently damage kidneys. Various prescription drugs can also cause problems, even when properly used. Drugs that cause kidney damage are called nephrotoxic. The terms nephrotoxicity and renal toxicity can be used interchangeably.
It is important for patients to be able to evaluate whether they are at risk for kidney damage and to balance the likelihood of such risk against the benefits obtained from a particular drugs.
Identification
Patients with kidney problems are most at risk for further kidney damage from drugs. Even drugs that are otherwise relatively harmless can seriously diminish kidney function and even cause renal failure in patients with kidney problems. This problem can be minimized by adjusting dose and selecting less nephrotoxic alternatives. In addition to asking their general practitioner about particular drugs, many kidney patients also run all potential drugs by their nephrologists.
Warnings
The National Kidney Foundation specifically warns kidney patients about the dangers associated with over-the-counter analgesics. They caution against taking the non-steroidal anti-inflammatory drugs ibuprofen, naproxen and Ketoprofen altogether unless specifically directed by a doctor, because "NSAIDs may cause an increased risk of sudden kidney failure and even progressive kidney damage." The National Kidney Foundation also warns against taking excessive aspirin, although they note that daily use of aspirin to prevent cardiac problems is usually acceptable, even in kidney patients.
Immunosuppressants
Ironically, one of the drugs given to kidney transplant patients is also nephrotoxic. Cyclosporine is an immunosuppressant given to prevent rejection of the kidney after transplant. In some instances, it is also prescribed before transplant to bring down urine protein levels. While acute toxicity is often reversible, damage is often permanent.
Patients taking cyclosporine need to be monitored so that signs of toxicity such as increased urine protein or serum creatinine can be recognized early and drug substitutions made.
While new drugs have been developed to replace cyclosporine, Dr. William Bennett, author of "Cyclosporine and Tacrolimus Nephrotoxicity," suggests that the commonly used tacrolimus has similar nephrotoxic effects.
Chemotherapeutic Agents
Chemotherapeutic drugs used to treat cancer are strong, powerful drugs whose many side effects also include kidney damage. Chemocare.com, the website associated with cancer survivor Scott Hamilton, indicates that chemotherapy drugs such as cisplatin, carboplatin, carmustine, mitomycin and high-dose methotrexate can cause renal problems even in non-kidney patients. Biological agents used to treat cancer, such as interleukin-2 or interferon alfa, can also cause renal problems.
Antibiotics
The growing number of bacteria that are resistant to penicillin and other antibiotics has driven the search for ever-stronger antibiotics. The side effects of some of these drugs, such as antibiotic amphotericin B, are so extreme that they are often administered in a hospital.
While almost any antibiotic can cause problems in patients with advanced kidney disease, drugs like vancomycin, the antibiotic used to treat MRSA, pose a risk for everyone. Chemocare.com indicates that the antibiotic gentamycin can also cause renal problems.
