Kidney failure, also known as renal failure, is diagnosed when the kidneys cannot adequately filter toxins and waste products from the blood. There are two forms of kidney failure, acute and chronic. Acute kidney failure occurs over a few days or weeks while chronic failure has a much longer onset. Acute kidney failure most often occurs in hospitals and can lead to the chronic form. There are many possible causes of kidney failure including many different drugs.
Function
There are essentially three ways in which drugs can lead to kidney injury and failure. Some drugs can cause severe dehydration and low blood pressure, so-called prerenal effects, which can injure kidneys and ultimately lead to kidney failure. A second method of kidney failure results from the kidney's exposure to toxic drugs as well as hypersensitivity or allergic reactions that damage kidney tissue or structures directly. Finally, side effects from some drugs can cause obstruction of urine through and out of the kidney leading to kidney damage and failure. Patients with pre-existing kidney disease, particularly the elderly, are at greater risk of kidney damage from drugs. Drug-induced kidney failure may be reversible if the offending drug is recognized and removed early.
Antibiotics
Certain antibiotics are commonly associated with kidney failure. Cephalosporins, erythromycin, gentamicin, penicillin-like drugs, sulfa-containing antibiotics, isoniazid and rifampicin are antibiotics that can injure kidney tissue resulting in kidney failure. The anti-fungal agent, amphotericin, and anti-viral drugs also may lead to kidney dysfunction by their toxic effects on kidney structures.
Analgesics
One of the most common forms of drug-induced kidney injury is from prolonged use of analgesics, most notably the nonsteroidal anti-inflammatory drugs such as ibuprofen. Kidney damage results from the drug's direct injurious effect on kidney tissue and structures. Elderly patients are at particular risk for this complication. Discontinuation of analgesics often results in improvement in kidney function.
Blood Pressure Medications
Angiotensin-converting enzyme, or ACE, inhibitors as well as angiotensin receptor II blockers are blood pressure medicines that can cause renal failure by their prerenal effects on tiny blood vessels in the kidney. Diuretics, drugs that lower blood pressure by decreasing circulating volume, can also cause kidney failure through their prerenal effects as well as direct toxicity to kidney tissue.
Radiocontrast Agents
Radiocontrast agents, also known as x-ray dye, are used for imaging during certain radiologic procedures such as angiography. These agents can directly injure kidney structures resulting in acute kidney failure. This serious side effect is less common with the newer contrast agents and occurs more often in patients with diabetes, pre-existing kidney disease, dehydration, liver disease and certain cancers.
Miscellaneous
There are numerous other drugs associated with acute kidney failure. Allopurinol, cimetidine, lithium and several cancer drugs have been reported to cause kidney failure as a result of direct damage to kidney tissue. Anticoagulants, or blood thinners, may cause excessive bleeding and blood clot formation which can obstruct flow of urine out of the kidneys leading to kidney congestion and injury. Crystal formation within the kidney leading to blockage of urine flow through the kidneys can be precipitated by some of the cancer drugs, sulfa drugs and antiviral drugs.
