Nephrotoxic drugs

Associate Editor-In-Chief:

Antibiotics

 * Aminoglycosides (10-15% Incidence of Acute Tubular Necrosis)
 * Occurs in 10-20% patients on 7 day course
 * Results in non-oligurics; increased Creatinine
 * A single dose early in septic course is usually safe


 * Sulfonamides
 * Amphotericin B (Incidence 80-90%)
 * Levofloxacin
 * Ciprofloxacin
 * Rifampin
 * Tetracycline
 * Acyclovir (only nephrotoxic in intravenous form)
 * Pentamidine

Chemotherapy and Immunosuppressants

 * Cisplatin
 * Methotrexate
 * Mitomycin
 * Cyclosporine

Heavy Metals

 * Mercury Poisoning
 * Lead Poisoning
 * Arsenic Poisoning
 * Bismuth
 * Lithium related kidney disorders
 * Polydipsia and Nephrogenic Diabetes Insipidus
 * Acute Renal Failure
 * Dialysis indications: Creatinine >2.5 or Seizures, ALOC, Rhabdomyolysis
 * Chronic kidney disease with fibrosis

AntiHyperlipidemics

 * Statins
 * Gemfibrozil
 * Associated with Acute Renal Failure due to Rhabdomyolysis


 * Fenofibrate (Tricor)
 * Increases Serum Creatinine without significant decrease in GFR
 * Serum Creatinine rise is reversible on stopping Fenofibrate

Chemotherapy

 * Cisplatin
 * Ifosphamide
 * Causes Fanconi's Syndrome

Miscellaneous Drugs

 * Chronic Stimulant Laxative use
 * Resulting chronic volume depletion and Hypokalemia causes nephropathy


 * Radiographic contrast
 * ACE Inhibitors
 * Expect an increase of Serum Creatinine in Chronic kidney disease


 * NSAIDs
 * Aspirin
 * Low dose Aspirin reduces Renal function in elderly
 * Decreased Creatinine Clearance after 2 weeks of use
 * Changes persisted for at least 3 weeks off Aspirin


 * Mesalamine (Asacol, Pentasa)
 * Mesalamine is an NSAID analog and has systemic absorption from the bowel


 * Penicillins and Cephalosporins
 * Hypersensitivity (fever, rash, arthralgia)


 * Sulfonamides
 * Vasculitis reaction


 * NSAIDs
 * Nephrotic Syndrome type reaction


 * Rifampin
 * Diuretics (Thiazides and furosemide)
 * Allopurinol
 * Cimetidine
 * Ciprofloxacin
 * Dilantin

Drugs of abuse

 * Cocaine