Drug-induced acute renal failure

Abstract

The frequency of in-hospital deterioration of renal function is about 2–5% [1, 2]. Nephrotoxic acute renal failure (ARF) is a major cause of ARF in hospitalized patients, accounting for 20–30% of ARF episodes [1, 3]. An exhaustive review of all nephrotoxic agents would certainly require a large textbook, since drug-induced nephrotoxicity is an emerging complication of a wide variety of therapeutic agents [4]. This chapter will therefore focus on the main predisposing factors and causes, such as drug-induced acute interstitial nephritis and ARF secondary to the agents most commonly used in clinical practice (i.e., antibiotics, radiocontrast media, nonsteroidal anti-inflammatory drugs, antineoplastic and immunosuppressive agents, and angiotensin-converting enzyme inhibitors). Special emphasis will be given to approaches aimed at avoiding or reducing the frequency of drug-induced ARF (i.e., prevention, less nephrotoxic alternatives, and early recognition of drug-related renal disease).