1. Iatrogenic Hospital Acquired Acute Kidney Injury: A wider scope for better outcomes
Dr. K. Hoe
MBBS DipMedSc DM (Int Med) FACP FUWI (Clinical Nephro)
Consultant Nephrologist, UWI (Mona)

2. Where is the origin of fire at the fire station?
Avoid nephrotoxic agents
Avoid NSAIDs & Aminoglycosides

3. Which is more important to set fire, lighter or fuel?
Exposures Susceptibilities
Sepsis Dehydration or volume depletion
Critical illness Advanced age
Circulatory shock Female gender
Burns Black race
Trauma CKD
Cardiac surgery Chronic diseases (heart, lung, liver)
Major noncardiac surgery Diabetes mellitus
Nephrotoxic drugs Cancer
Radiocontrast agents Anemia
Poisonous plants and animals CKD, chronic kidney disease; CPB, cardiopulmonary bypass
2012 KDIGO guidelines for AKI

5. Kk hoe et al; e-published. DOI 7727/wimj.2018.154

6. Anything missing? Exposures Susceptibilities
Sepsis Dehydration or volume depletion
Critical illness Advanced age
Circulatory shock Female gender
Burns Black race
Trauma CKD
Cardiac surgery Chronic diseases (heart, lung, liver)
Major noncardiac surgery Diabetes mellitus
Nephrotoxic drugs Cancer
Radiocontrast agents Anemia
Poisonous plants and animals CKD, chronic kidney disease; CPB, cardiopulmonary bypass
2012 KDIGO guidelines for AKI

7. Factors Associated with Drug-Induced Nephrotoxicity
Drugs
Exposure
Patient

8. Drug factors for nephrotoxicity
Abs (Pen, S’mide)
NSAIDs, PPI, Aminoglycoside
aminoglycosides platinums, amphotericin B and colistin
positive charge of polycationic aminoglycosides
methotrexate, acyclovir, indinavir/atazanavir, sulfadiazine, vitamin C, foscarnet, oral sodium-phosphate, and triamterene
adefovir, cidofovir, tenofovir disturb mitochondrial function
dextran, hydroxyethyl starch accumulate within phagolysosomes
 interaction of uromodulin with vancomycin

9. strategic handling of AKI

10. Patient factor Comorbid Diseases
Patients with HIV receiving tenofovir who developed Fanconi syndrome were noted to have a single nucleotide polymorphism
Comorbid Diseases

11. Gender distribution of HA-AKI cases and its severity at UHWI

12. kk hoe et al unpublished data

13. Factors Associated with Drug-Induced Nephrotoxicity
Drugs
Exposure
Patient

14. Drug‐Associated Acute Kidney Injury Identified in the United States Food and Drug Administration Adverse Event Reporting System Database
Most AKI reports were generated for medications not recognized as nephrotoxin
Hanna K et al ACCP jnl: August 2018; 38 (8):
Total # of AKI (n=193996)
Prevalence of exposure
Known nephrotoxin
16.5%
New potential nephrotoxin
64.8%
Possible nephrotoxin
18.6%

15. Drug
ROR
95% CI
Aprotinin
115.7
110.63,
Sodium phosphate
55.81
51.78, 60.17
Frusemide
12.61
11.94, 13.32
Vancomycin
12.19
11.45, 12.99
Metformin
10.65
10.31, 11.00

16. Kk hoe et al on going trial 2016-18

17. Wider scope is necessary to prevent Iatrogenic HA-AKI
Drugs
Exposure
Patient

18. Conclusion
Know