Muriel Lily drug induced nephrotoxicity

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<p>Prelude to my talk..</p> <p>Nephrotoxic Drugsprescribed by Family doctors</p> <p>TOP 5</p> <p>By Muriel Lily, PGY1</p> <p>At-risk population Age &gt; 60 DM CHF, cirrhosis Sepsis GFR &lt; 60 Volume depleted Already on a nephrotoxin</p> <p>Approach to the at-risk patient Before prescribing: Use nonnephrotoxic drugs if possible Avoid multiple Reduce risk factors Adequate hydration before and during therapy baseline renal fxn dosage adjust</p> <p> When starting nephrotoxin: monitor renal fxn &amp; vitals *Creatinine elevated from baseline by 44mmol/L(0.5mg/dL) or &gt;133mmol/L (1.5mg/dL) = ARF</p> <p>#</p> <p>Antibiotics Penicillins, Cephalosporins, Fluoroquinolones Fever, rash, progressive RF, eosinophilia, prolonged therapy Allergy Renal Biopsy Rx: Stop drug Steroids</p> <p>Antibiotics (cont) Aminoglycosides Trough &gt;2mg/L, repeated course in months nonoliguric ATN Recommendations: hi OD dose (5-7mg/kg/24h x 2-3wks) is less nephrotoxic and equally effective Follow levels, correct K CrCl &gt; 60, 1-2.5mg/kg Q8H CrCl 40-60, Q12H CrCl 20-40, Q24H CrCl 300 umol/L consult nephrology! Avoid in bilat renal artery stenosis ARB causes less renal failure than ACE Inhibitor</p> <p> Strategy: In 1/52: BP, K, Cr diuretic holiday x days before start start captopril 1st, then long-acting Ramipril: CrCl &lt; 40, give 25% of normal dose Losartan: avoid if GFR &lt; 30</p> <p>#</p> <p>Sulfa Drugs Crystals Acute oliguric renal failure Commonly: Septra, Furosemide, HCTZ, MTX Recommendations: Septra DS: CrCl 15-30, 50% of normal dose Lasix: max 1-3g/d to initiate desired response HCTZ: CrCl 133mmol/L (1.5mg/dL) = ARFSTOP DRUG! Consult Nephrology?</p> <p>References </p> <p>Naughton, C. Drug-induced Nephrotoxicity. AFP. 2008 Sept 15: 743-750. Guo, X. How to prevent, recognize, and treat drug-induced nephrotoxicity. Cleveland Clinic Journal of Medicine April 2002 vol. 69 4 289-290 Barclay, L. Recommendations Issued for Drug-Induced Nephrotoxicity. MedscapeCME. 2008. Sept 30. www.fpnotebook.com Hewlett, T. Nephrotoxic drugs. CFP. May 2004</p>