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Nephrotoxic Agents
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ACE Inhibitors
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.
Chemotherapy agents (e.g., Cisplatin)
Can cause tubular damage, electrolyte imbalances, and chronic kidney disease. Hydration, dose limitations, and alternative therapies might reduce risks.
Calcineurin Inhibitors (e.g., Cyclosporine, Tacrolimus)
Can lead to chronic kidney disease through inducing vasoconstriction of afferent arterioles. Monitoring drug levels and kidney function and adjusting doses can help.
Heavy Metals (e.g., Lead, Mercury)
May result in tubulointerstitial disease and acute kidney injury. Chelation therapy and avoidance of further exposure are key preventive strategies.
Diuretics
Excessive use can cause dehydration and electrolyte imbalances, leading to acute kidney injury. Proper dosing and monitoring of electrolytes can mitigate risk.
Lithium
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.
Contrast-induced nephropathy
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.
NSAIDs (Nonsteroidal anti-inflammatory drugs)
May cause reduction in renal blood flow and acute kidney injury. Mitigation includes careful dosing and monitoring renal function, especially in vulnerable patients.
Radiocontrast agents
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.
Ethylene Glycol
Metabolism of ethylene glycol produces crystals that can cause acute kidney injury. Immediate treatment with fomepizole or ethanol and hemodialysis to prevent kidney failure.
Rhabdomyolysis
The breakdown of muscle tissue releases myoglobin which can cause kidney damage. Hydration and alkalinization of urine are treatment strategies to prevent renal failure.
Aminoglycoside antibiotics
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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