Лекарственно-индуцированная кристаллическая нефропатия

Abstract

Drug-induced (DI) crystal nephropathy (CN) is a relatively rare kidney disease that is not always easy to diagnose and potentially leads to acute kidney injury (AKI), which may lead to the need for haemodialysis and is associated with a high risk of mortality. Th e aim of the review was analysis and systematisation of data on drugs, the intake of which is associated with development of DICN, conditioning the increased risk of drug-induced AKI, on its pathophysiological mechanisms, analysis of possible methods of treatment and prevention. The search for the specifi ed keywords was carried out in the eLIBRARY.RU, PubMed®, MEDLINE, EMBASE databases, guidelines and methodological recommendations, materials of databases of adverse reactions, instructions for the medical use of drugs published within the period up to June 2021. Most often, DICN is associated with the use of such drugs as sulfadiazine, acyclovir, indinavir, triamterene, methotrexate, as well as orlistat, ciprofl oxacin, amoxicillin, oral sodium phosphate preparations, etc. Th e main pathophysiological mechanism of CN development is the precipitation of poorly soluble substances in the urine and formation of crystals. Th ereat, one part of the drug crystallises and the precipitate falls out directly into the renal tubules, the other part acts through a change in metabolism, increasing the concentration of other poorly soluble compounds in the urine. The risk factors for DICN include the risk factors for AKI as well as drug-specifi c risk factors, such as urine pH. Clinically, СN is most oft en manifested by symptoms of AKI, sometimes with development of acute renal colic and hematuria. In СN treatment, it is required to cancel the inducer drug or reduce its dose, stimulate diuresis with replenishment of the intravascular fluid volume using infusions of balanced electrolyte solutions. For the prevention of DICN, it is important to take into account all possible risk factors for its development, use adequate doses of drugs and avoid the prescription of potentially nephrotoxic drugs