tailieunhanh - Ebook National kidney foundation’s primer on kidney diseases (7/E): Part 2

Part 2 book “National kidney foundation’s primer on kidney diseases” has contents: Kidney disease caused by therapeutic agents, principles of drug therapy in patients with reduced kidney function, genetics and kidney disease, genetically based kidney transport disorders, sickle cell nephropathy, and other contents. | 35  Kidney Disease Caused by Therapeutic Agents Mark A. Perazella; Anushree C. Shirali Medications are a mainstay of appropriate patient care, and new agents are being introduced into clinical practice at a rapid pace. Although most drugs are well tolerated, and therapeutic agents are often essential for medical care, kidney injury remains an unfortunate and relatively frequent adverse consequence. This bespeaks the fact that some individuals possess risk factors that predispose to drug-induced kidney toxicity. Not unexpectedly, the general population is regularly exposed to various diagnostic and therapeutic agents with nephrotoxic potential. Although most are prescribed, many other preparations are purchased over the counter. Drugs fall into the categories of diagnostic agents, therapeutic medications, alternative or complementary substances, and drugs of abuse, resulting in a variety of kidney syndromes (Table ). KIDNEY SUSCEPTIBILITY TO   NEPHROTOXIC AGENTS In addition to clearance of endogenous waste products, excretion of sodium and water, electrolyte and acid-base balance, and endocrine activity, the kidney is responsible for the metabolism and excretion of exogenously administered drugs, making it susceptible to various types of injury. There are several factors that increase the kidney’s susceptibility to these potential toxins, which can be classified into three simple categories (drug-related factors, kidney-related factors, and host-related factors) and often occur in combination to promote nephrotoxicity. As we learn more about drug-induced kidney disease, it appears that these factors explain much of the variability and heterogeneity noted among patients. Drug-related factors are the critical first step to the development of nephrotoxicity. Innate drug toxicity is important because the drug or its toxic metabolite may cause kidney injury by impairing renal hemodynamics, direct cellular injury, osmotic injury, or intratubular crystal deposition,