1. Presented By Dr / Said Said Elshama
Nephrotoxicity
Presented By
Dr / Said Said Elshama

2. Learning objectives Nephrotoxicity definition .
Mechanisms of nephrotoxicity.
Drugs induced nephrotoxicity.
Clinical picture of nephrotoxicity.
Management of nephrotoxicity.

3. Definition Disturbance or harmful effect on the kidney.
By introducing drugs or toxic substances into the body . .

4. Mechanisms of nephrotoxicity
intraglomerular hemodynamic
acute tubular cell necrosis
Inflammation
Rhabdomyolysis
Crystal nephropathy
Thrombotic microangiopathy

5. Intra-glomerular pressure
GFR
Intra-glomerular pressure
Urine output
Angiotensin 11- Mediated vasoconstriction of efferent arterioles (ACE inhibitors)
Prostaglandin Mediated vasodilatation of afferent arterioles (NSAID)

6. Acute tubular cell necrosis
Concentrating glomerular filtrate
Reabsorbing
glomerular filtrate
Renal tubular cells
Acute tubular cell necrosis
Aminoglycosides
Cisplatin

7. inflammation Glomerulonephritis Acute interstitial nephritis
Chronic interstitial nephritis
Ex. NSAID, rifampicin, vancomycin, antiviral
inflammation

8. Ex . Acyclovir, ciprofloxacin
Crystal nephropathy
Ex . Acyclovir, ciprofloxacin
Urinary pH
Concentration of drug
Volume depletion
Renal insufficiency

9. Ex. Cocaine heroin , amphetamine
Rhabdomyolysis
Ex. Cocaine heroin , amphetamine
Tubular obstruction
Alteration in GFR
Direct toxicity

10. Thrombotic Microangiopathy
Immune mediated reaction
Direct endothelial toxicity
Thrombotic Microangiopathy
Antiplatelets(cyclosporine)

11. Causes of nephrotoxicity
Antibiotics
Analgesics
Heavy metals
Contrast agents
Anti cancer
Solvents
Herbicides and pesticides
Overproduction of uric acid

12. Risk Factors Age Underlying kidney disease Severe dehydration
Prolonged exposure to toxic agents
heart failure
Sepsis
Renal insufficiency (GFR is less than 60 ml/m
Overproduction uric acid disease
Intravascular volume depletion

13. Factors affecting susceptibility of kidney to toxicants1
High renal blood flow LL 2
Concentration of chemicals 3
Re-absorption and secretion of chemicals 4
Activation pro-toxicants to reactive

14. Common nephrotoxic drugs
Non steroidal anti - inflammatory
Aspirin- ibuprofen
Aminogycosides
Gentamycin
Antibiotics
Vancomycin
Antiviral
Acyclovir

15. Clinical picture Excess urea in the blood (azotemia) Anemia Acidosis
Over hydration
Hypertension
Heamturia
Pyuria
Oliguria
Seizures
Coma

16. DIAGNOSIS Examination Urine analysis Renal functions tests
History taking
Examination
Investigations
Urine analysis
Renal functions tests

17. Management Diagnosis Treatment Prevention History Examination
Investigation
Treatment
Prevention

18. Treatment Stop the drug Remove the toxin Diuretics Chelation
Hemodialysis
Hemoperfusion

19. Prevention
Adjust dose
Assess renal function
Avoid nephrotoxic combinations
Correct risk factors
Ensure adequate hydration
Use non-nephrotoxic drugs

20. Questions Mechanism of gentamycin nephrotoxicity is
intraglomerular hemodynamic
acute tubular cell necrosis
Inflammation
Thrombotic microangiopathy
Crystal nephropathy

21. Questions
If patient has tobramycin nephrotoxicity, the first step of treatment is to:-
Give excess fluid
Slow the infusion rate
Stop the medication
Add antidote

22. Questions Antiprostaglandin activity of nephrotoxic drugs due to
Vasodilatation of efferent arterioles
Vasodilatation of afferent arterioles
Vasoconstriction of afferent arterioles
Vasoconstriction of efferent arterioles

23. Thank you
Thank you
Thank you
Thank you