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Nephrotoxic Agents

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ACE Inhibitors

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May lead to reduced glomerular filtration rate and acute kidney injury, particularly in cases of renal artery stenosis. Avoiding use in high-risk scenarios and regular monitoring of kidney function are mitigation methods.

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Chemotherapy agents (e.g., Cisplatin)

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Can cause tubular damage, electrolyte imbalances, and chronic kidney disease. Hydration, dose limitations, and alternative therapies might reduce risks.

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Calcineurin Inhibitors (e.g., Cyclosporine, Tacrolimus)

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Can lead to chronic kidney disease through inducing vasoconstriction of afferent arterioles. Monitoring drug levels and kidney function and adjusting doses can help.

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Heavy Metals (e.g., Lead, Mercury)

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May result in tubulointerstitial disease and acute kidney injury. Chelation therapy and avoidance of further exposure are key preventive strategies.

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Diuretics

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Excessive use can cause dehydration and electrolyte imbalances, leading to acute kidney injury. Proper dosing and monitoring of electrolytes can mitigate risk.

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Lithium

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Long-term use may cause chronic kidney disease and nephrogenic diabetes insipidus. Regular kidney function monitoring and maintaining a consistent sodium intake can prevent damage.

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Contrast-induced nephropathy

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Exposure to radiographic contrast media can result in a form of acute kidney injury. Pre-hydration, using non-ionic low-osmolality contrast agents, and ensuring minimal exposure can reduce risk.

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NSAIDs (Nonsteroidal anti-inflammatory drugs)

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May cause reduction in renal blood flow and acute kidney injury. Mitigation includes careful dosing and monitoring renal function, especially in vulnerable patients.

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Radiocontrast agents

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Can induce contrast-induced nephropathy leading to acute kidney injury. Hydration, using lowest possible dose, and utilizing less nephrotoxic agents are ways to mitigate risk.

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Ethylene Glycol

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Metabolism of ethylene glycol produces crystals that can cause acute kidney injury. Immediate treatment with fomepizole or ethanol and hemodialysis to prevent kidney failure.

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Rhabdomyolysis

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The breakdown of muscle tissue releases myoglobin which can cause kidney damage. Hydration and alkalinization of urine are treatment strategies to prevent renal failure.

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Aminoglycoside antibiotics

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Can cause acute tubular necrosis and renal failure. Mitigation strategies involve dose adjustment, monitoring drug plasma levels, and ensuring adequate hydration.

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