Nephrotoxic medicines

Last updated: Sunday, July 12, 2015

The three commonest causes of drug-induced renal impairment are:

Functional Renal Impairment
Drugs reduce GFR by temporarily affecting the physiology of the kidney (e.g. NSAIDs reduce blood flow through the kidney).

Acute Kidney Injury
Drugs physically damage the structures of the kidney (e.g. necrosis of tubules with aminoglycosides).

An immune-based inflammatory reaction within the kidney (e.g. penicillins, gold salts).

Drugs that are potentially nephrotoxic should be preferably avoided in any patients with renal impairment as their renal reserve is less and any ill effects may lead to acute kidney injury. In end-stage renal failure, where patients are permanently on dialysis and GFR is typically less than 5mL/min, renal function cannot get any worse so the use of potentially nephrotoxic drugs is often acceptable if clinically indicated.