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There are various forms, [2] and some drugs may affect kidney function in more than one way. Nephrotoxins are substances displaying nephrotoxicity. Nephrotoxicity should not be confused with some medications predominantly excreted by the kidneys needing their dose adjusted for the decreased kidney function (e.g., heparin, lithium).
Patients with kidney loss should be monitored for hypertension (and treated for it if discovered) and avoid nephrotoxic drugs such as certain pain relievers and intravenous contrast agents. Such patients who are unable to communicate effectively (due to age or intellectual disability) are at risk of dehydration.
Some of the most commonly used nephrotoxic medications are non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. [47] With worsening kidney function, it might also be necessary to follow a renal-diet to avoid complications such as hyperkalemia and metabolic acidosis.
[5] [16] Other nephrotoxic drugs should be avoided. Nephrotoxicity is usually reversible and can be reduced by dosage adjustment and adequate hydration. [17] Electrolyte disturbances — hypocalcemia and hypomagnesemia can occur [17] [18] and regular monitoring of electrolytes is necessary to avoid clinical toxicity. [5] [19]
Drugs ( e.g. gold salts, penicillin, captopril): [25] gold salts can cause a more or less important loss of proteins in urine as a consequence of metal accumulation. Penicillin is nephrotoxic in people with kidney failure and captopril can aggravate proteinuria.
The scarring of the small blood vessels, called capillary sclerosis, is the initial lesion of analgesic nephropathy. [7] Found in the renal pelvis, ureter, and capillaries supplying the nephrons, capillary sclerosis is thought to lead to renal papillary necrosis and, in turn, chronic interstitial nephritis.
Next, thrust in an inward and upward motion on the diaphragm. This will force air out of the lungs and remove the blockage. Repeat these abdominal thrusts up to five times, the doctor advised.
Common causes of ATN include low blood pressure and use of nephrotoxic drugs. [2] The presence of "muddy brown casts" of epithelial cells found in the urine during urinalysis is pathognomonic for ATN. [3] Management relies on aggressive treatment of the factors that precipitated ATN (e.g. hydration and cessation of the offending drug).