As the saying goes, “It is a three-point drug.” Today we talk about the drug-related kidney damage. Drug-induced renal damage usually refers to a drug-induced kidney disease caused by adverse drug reactions or adverse events. It is a group of diseases caused by different drugs, with different clinical features and different pathological types.
Which situations are prone to drug-induced kidney damage?
1. Previous kidney disease or renal insufficiency
2. Insufficient renal blood flow or poor perfusion
3. Senior patients
Four, combined with multiple drugs due to complex or chronic diseases
V. Abnormal liver function
Six, decreased cardiac output or insufficient blood volume
Seven, allergic constitution or history of drug allergy
8, the drug dose is too large or the treatment is too long
If you apply suspicious drugs after the appearance of dark urine, urine foam Increased, decreased urine output, edema of the lower extremities of the eyelids, fatigue, fatigue, loss of appetite, nausea, vomiting, etc., please go to the Department of Nephrology for diagnosis and treatment as soon as possible.
We also need to know which drugs are prone to kidney damage?
To the kidney The top four antibiotics are β-lactams, quinolones, macrolides, and other anti-infectives (such as antifungals, antivirals, etc.). Drug-induced renal damage caused by aminoglycosides and anti-tuberculosis drugs has been significantly reduced. –lactams: penicillins, cephalosporins; quinolones: norfloxacin, ofloxacin, ciprofloxacin; macrolides: erythromycin; aminoglycosides: netilmicin, et al Michelin, gentamicin, amikacin.
Second, some Chinese medicine
including horses The botanicals and related Chinese patent medicines of the aristolochic acid are widely used in clinical practice. These drugs have different functions such as clearing away heat and dampness, detoxifying and reducing swelling, clearing the lungs and lowering the gas, promoting qi and activating blood circulation, relieving phlegm and relieving pain. Used in the digestive system, urinary system, respiratory system, cardiovascular diseases. A tubulointerstitial disease caused by a drug containing aristolochic acid is called aristolochic acid nephropathy. The disease is mostly a chronic course. It often has a history of long-term or intermittent taking of a proprietary Chinese medicine containing aristolochic acid. The clinical manifestations are concealed. The disease may have been discontinued for many years. The characteristics are consistent with chronic interstitial nephritis, and most of them are chronic progressive. Renal failure. About 30-40% may be associated with urinary tumors, ranging from medication to tumors for up to 10 years. There is currently no effective treatment for aristolochic acid nephropathy.
Other heavy metal drugs, such as lead or mercury, can cause proteinuria and renal dysfunction, and should also be investigated.
Third, contrast agent
With The improvement of diagnostic level, the use of contrast agents in clinical applications is more and more common, such as enhanced CT, cardiology coronary stent implantation, intracranial angiography, lower extremity angiography. Contrast-induced nephropathy is generally defined as acute renal insufficiency after the use of contrast agents, with an increase in creatinine of 44 umol/L (0.5 mg/dl) or a 25% increase over the baseline value. Who is susceptible to contrast nephropathy?
1, old age (especially more than 70 years old).
2, there are kidney diseases (especially diabetes) before the use of contrast agents.
3, dehydration status (diarrhea, excessive sweating, low food intake, excessive diuresis, insufficient blood volume, etc.).
4, congestive heart failure.
5. Use certain drugs (such as painkillers, etc.) at the same time.
Contrast agents should be avoided for these high-risk groups. If you need to use corrective risk factors and prevent them, such as hydration treatment, if necessary, blood purification treatment.
Four, antipyretic and analgesic drugs
The side effects of antipyretic analgesics include gastrointestinal tract, nervous system, allergic reaction and liver and kidney damage. Commonly used are aspirin, acetaminophen, Baifuning, Baijiahei, Tylenol, Fenbid, Futalin. Wait.
5. Angiotensin-converting enzyme inhibitor/angiotensin receptor inhibitor (ACEI/ARB)
ACEI/ARB is commonly used in patients with hypertension, proteinuria, diabetic nephropathy, heart failure, and myocardial infarction. It is widely used clinically, but improper use can lead to Kidney damage. Bilateral renal artery stenosis, hypovolemia, congestive heart failure, and the simultaneous use of diuretics or antipyretic analgesics should be used with caution or disabled. Start with a small dose at the beginning of use and monitor renal function and blood potassium. When the creatinine level is greater than 265.2umol/L (3mg/dl), it is generally not used. When the creatinine level is 220.8-265.2umol/L (2.5-3mg/dl), use it with caution. However, dialysis patients can be used and blood potassium needs to be monitored. Should be used under the guidance of a nephrologist.
Finally, how should we prevent drug-related kidney damage?
First, choose drugs without nephrotoxicity or nephrotoxicity when choosing drugs.
Second, avoid and correct various risk factors when using drugs.
Third, it is necessary to formulate individualized drug delivery programs, adjust the drug dosage, administration interval and route according to renal function, and avoid the combined use of multiple nephrotoxic drugs.
Fourth, the urine volume and renal function should be closely monitored during the medication.
5. Once suspected, immediately suspend suspicious drugs and treat them early.
Drug is a very important “weapon” for doctors. Drug treatment has caused many patients to get rid of the disease, but sometimes it is also a “double-edged sword.” The majority of patients and friends must make individualized drug delivery programs under the guidance of doctors, and develop their strengths and avoid weaknesses to get the most benefit!
author:? Zhang Yanjing