Abstract
Background: Drug-induced acute kidney injury is a common situation in clinical practice. Many treatments are involved and they are even more aggressive when associated with a predisposing factor such as diabetes. We aimed to investigate clinical features of acute drug-induced kidney injury in diabetics in order to clarify renal prognosis. Methods: This was a descriptive and analytical retrospective study including diabetics who presented drug-induced acute kidney injury, conducted in our department during the period from 1986 to 2015. Acute kidney injury was classified according to Kidney Disease Improving Global Outcomes criteria. We analyzed medical records of patients. Results: 31 patients were included with mean age of 65.41 years and gender ratio M/F at 0.93. Diabetes was type 2 in 97% of cases. Mean previous creatinine clearance was 39.33 ml/min/1.73 m2. Drugs involved were blockers of renin-angiotensin system (35%), aminoglycosides (16%), non-steroidal anti-inflammatory (16%), diuretics (13%), lipid-lowering agents (10%), rifampicin (6%) and ifosfamide (3%). Extracellular dehydration was present in nine cases (29%). Main drug combinations were with diuretics in 16 cases (52%) and with ACE inhibitor or ARB in eight cases (26%). Oligo anuria was observed in 5 cases (16%). Proteinuria with urine strips was objectified in 25 cases (81%). Acute kidney injury was grade 3 in 24 cases (77%), grade 2 in three cases (10%) and grade 1 in four cases (13%). Renal survival at 102 months was 57%. Identified renal prognosis factors were serum phosphorus >1.47 mmol/l (p = 0.01), proteinuria at urine strips (p = 0.042), dehydration (p = 0.013), oral antidiabetic treatment (p = 0.038), intravenous rehydration (p = 0.021) and insulin (p = 0.006). Conclusion: Drug-induced acute kidney injury is potentially serious in diabetics. Prevention is essential to improve the prognosis of this renal damage.
Highlights
Drug-induced acute kidney injury (AKI) is frequent in clinical practice [1]
Stages of chronic kidney disease (CKD) were defined according to the International Foundation Kidney disease Improving Global outcomes (KDIGO) [7]
Among 182 diabetic patients presenting an AKI during the period of the study, we identified 31 cases of drug induced AKI (17%)
Summary
Drug-induced acute kidney injury (AKI) is frequent in clinical practice [1]. the kidney is an organ vulnerable to drug toxicity in the body by its own functions of filtration, concentration and disposal as well as its rich vascularization [2].Involved drugs are numerous with multiple mechanisms. Treatments involved are even more aggressive when associated with one or more predisposing factors including diabetics [3]. Drug-induced AKI represents iatrogenic adverse events, mostly preventable, whose prognosis is typically better than other etiologies of AKI They are potentially serious since they are associated with high morbidity and mortality and the risk of progression to end stage kidney disease (ESKD) [4]. We aimed to investigate clinical features of acute drug-induced kidney injury in diabetics in order to clarify renal prognosis. Identified renal prognosis factors were serum phosphorus >1.47 mmol/l (p = 0.01), proteinuria at urine strips (p = 0.042), dehydration (p = 0.013), oral antidiabetic treatment (p = 0.038), intravenous rehydration (p = 0.021) and insulin (p = 0.006). Prevention is essential to improve the prognosis of this renal damage
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