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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).
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.
European guidelines classify a pre-existing decreased kidney function to be a risk factor of contrast-induced nephropathy in the following cases: [5]. Estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73 m 2 of body surface area before intra-arterial administration with first-pass renal exposure (not passing lungs or peripheral circulation before kidneys), or in the intensive care unit
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.
ATN may be classified as either toxic or ischemic.Toxic ATN occurs when the tubular cells are exposed to a toxic substance (nephrotoxic ATN).Ischemic ATN occurs when the tubular cells do not get enough oxygen, a condition that they are highly sensitive and susceptible to, due to their very high metabolism. [4]
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.
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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.