Clinical analysis of drug-induced kidney injury in 20 inpatients

Abstract

Objective To understand the clinical features of drug-induced kidney injury (DIKI) in inpatients. Methods The medical records data of inpatients diagnosed as DIKI from January 31, 2010 to January 31, 2017 were retrospectively analyzed. The main analytic indicators included general conditions of patients, degree of renal damage, outcomes, and suspected drugs causing acute kidney injury (AKI), and so on. Results A total of 20 patients were entered into this study, including 16 males (80.0%) at age 8 to 80 years and the average age of (44±20) years, 4 females (20.0%) at age 27 to 71 years and the average age of (49±22) years. Eleven patients (55.0%) were ≤44 years old (young people), 4 patients (20.0%) were 45-59 years old (middle-aged people), 5 patients (25.0%) were ≥60 years old (old people). The kinds of diseases were 2 to 6 in each patient in the 20 patients. Of them, 3 patients (15.0%) had 2 kinds of diseases at the same time, 7 patients (35.0%) had 3 kinds of diseases, 5 patients (25.0%) had 4 kinds of diseases, 4 patients (20.0%) had 5 kinds of diseases, 1 patient (5.0%) had 6 kinds of diseases. The serum creatinine (Scr) and blood urea nitrogen (BUN) values in the 20 patients were 56.0-132.5(89.1±22.1)μmol/L and 2.9-8.5(4.9±1.6)mmol/L before medication, respectively and significantly increased to 128.0-506.0 (241.8±112.8) μmol/L and 4.3-28.0 (13.0±5.9) mmol/L after medication, respectively. After treatments with hemodialysis or renal protective drugs, the Scr and BUN values were significantly reduced to 52.0-439.0(174.8±97.5) μmol/L and 1.0-27.6(9.3±7.1)mmol/L, respectively. The differences of Scr and BUN levels between before medication and after medication, before treatment and after treatment were statistically significant (all P<0.05). All DIKI during hospita-lization were AKI. Six patients (30.0%) were in AKI stage 1, 10 patients (50.0%) in AKI stage 2, and 4 patients (20.0%) in AKI stage 3 (acute renal failure). By the time of discharge, 5 patients were cured, in 12 patients the condition was improved, 1 patient had no change, in 1 patient the condition was deteriorated, and 1 patient died. The effective rate of treatments was 85.0%. A total of 29 kinds of drugs were used in combination in the 20 inpatients, and 6-24(14±5) kinds of drugs were used in each patient. Five categories and 12 drugs were found to induce kidney injury in this study, involving antibacterial drugs(15 patients), chemotherapeutic drugs (2 patients), antiviral drugs (2 patients), immunosupp-ressants (3 patients), and anti-gout drugs(1 patient). Kidney damage was clearly documented in the instructions of all above-mentioned drugs. The time from medication to onset of DIKI was 1-56 days and the median time was 9 days. Conclusions Antibacterial drugs, especially antifungal drugs such as amphotericin B, were the main drugs causing kidney injury in hospital. The DIKI was AKI during hospitalization, and the treatment effect for AKI was good. Key words: Acute kidney injury; Drug-related side effects and adverse reactions; Inpatients