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Topic: Nephrotoxicity

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	Nephrotoxicity Summary
		Nephrotoxic injury is damage to one or both of the kidneys that results from exposure to a toxic material, usually something taken by mouth.
		Nephrotoxic injury can lead to acute renal failure, in which the kidneys suddenly lose their ability to function, or chronic renal failure, in which kidney function slowly deteriorates.
		Nephrotoxicity is a poisonous effect of some substances, both toxic substances and medication, on the kidney.
	www.bookrags.com /Nephrotoxicity (824 words)

	Nephrotoxicity
		Nephrotoxicity is one of the more problematic adverse effects of antifungal therapy, specifically with amphotericin B. Although generally reversible, up to 10% of patients with significant kidney dysfunction on amphotericin B will require persistent dialysis after discontinuation of the antifungal [Groll, Piscitelli et al.
		Amphotericin B nephrotoxicity can be classified by two mechanisms: 1) the effects of amphotericin B on renal blood flow and glomerular filtration, and 2) the direct toxic effects of amphotericin B on (primarily) the distal tubules.
		Probably the best-studied approach for reducing nephrotoxicity with amphotericin B is to administer one of three lipid formulations of amphotericin B (LFAB): ABCD; Amphocil™ or Amphotec™, ABLC; Abelcet™, or L-AMB; Ambisome™.
	www.doctorfungus.org /thedrugs/Nephrotoxicity.htm (744 words)

	Nephrotoxicity associated with exposure to chemicals, principles and methods for the assessment of (EHC 119, 1991)
		The effects of chemicals on kidneys with pre-existing renal lesions 2.5.8.1 Nephrotoxicity in the presence of renal and extrarenal disease 3.
		Nephrotoxicity can be defined as renal disease or dysfunction that arises as a direct or indirect result of exposure to medicines, and industrial or environmental chemicals.
		In young individuals nephrotoxicity in terms of tubular necrosis may be compensated for by constant repair, while in older patients this repair capacity may be diminished, resulting in the clinical expression of renal injury (Laurent et al., 1988).
	www.inchem.org /documents/ehc/ehc/ehc119.htm (14009 words)

	THE MERCK MANUAL, Sec. 17, Ch. 226, Toxic Nephropathy
		Nephrotoxicity may also occur from normal ions circulating in abnormal concentrations (eg, from hypokalemia, hyperkalemia, hypomagnesemia, or hyperuricemia).
		Salicylates have direct nephrotoxicity in overdose and a synergistic role in mixed analgesic nephropathy; they are common components in many drugs.
		Iron nephrotoxicity is associated with proximal myopathy in patients with hemochromatosis and other forms of iron overload (see Ch.
	www.merck.com /pubs/mmanual/section17/chapter226/226a.htm (1187 words)

	Evaluation of the Nephrotoxicity of Complex Mixtures Containing Organics and Metals: Advantages and Disadvantages of ... (Site not responding. Last check: 2007-10-22)
		In this study, evaluation of the nephrotoxicity of complex industrial waste mixtures containing both organics and metals will be used to illustrate the advantages and disadvantages of the use of real-world complex mixtures in toxicologic evaluation of chemical interactions.
		With nephrotoxicity defined as increased kidney weight (either absolute or relative) coupled with a significant alteration in at least one serum parameter, samples A, E, G, and L were nephrotoxic.
		Nephrotoxicity of hexachloro-1:3-butadiene in the rat: the effect of age, sex and strain.
	ehp.niehs.nih.gov /members/1995/Suppl-1/simmons-full.html (3169 words)

	Postgraduate Medicine: Renal Problems Symposium: Nephrolithiasis
		When the frequency of nephrotoxicity is assessed, it becomes clear that most renal injury tends to cluster around certain patients and specific clinical situations that represent risk factors.
		To evaluate nephrotoxicity, it is necessary to define exactly the increases in serum creatinine concentration that will be used clinically to signal its presence.
		Although the exact incidence of drug-induced nephrotoxicity is not known, it is important for clinicians to be aware of the risks in certain patients and to know which drugs are the most commonly implicated.
	www.postgradmed.com /issues/1996/12_96/thatte.htm (4472 words)

	Incidence of and Risk Factors for Tenofovir-Induced Nephrotoxicity: A Retrospective Cohort Study (Site not responding. Last check: 2007-10-22)
		The propensity to cause nephrotoxicity is a well-known trait of nucleotide analogues.
		Because the risk of nephrotoxicity with TDF may be dose-related, the receipt of concomitant agents that increase TDF levels may inadvertently increase the risk of eliciting this adverse effect.
		Virtually all cases of nephrotoxicity published thus far have been in patients who have been receiving TDF with either lopinavir/ritonavir or ritonavir in combination with another PI, lending some support to this theoretical association.
	www.hivdent.org /drugs1/drugIRFT0705.htm (3322 words)

	NDI Article: 16 (Site not responding. Last check: 2007-10-22)
		Nephrotoxicity grading was re-evaluated at a median of 23 (10-26) months after the baseline study in 13 children; eight children had died, and two were not evaluable (one received cisplatin after the baseline study; the other received bicarbonate replacement treatment, which precludes accurate grading).
		Ifosfamide was discontinued early due to nephrotoxicity in two patients (one with nephrogenic diabetes insipidus, one with acute renal failure); one of these received no further treatment, the other continued cyclophosphamide-based chemotherapy.
		Of 13 children with evaluable nephrotoxicity scores at baseline and follow-up, the nephrotoxicity grade (ie, no, mild, moderate, or severe) was increased in seven, unchanged in five, and decreased in one.
	www.ndif.org /Article/jar-16.html (1853 words)

	Inorganic fluoride nephrotoxicity
		Inorganic fluoride nephrotoxicity: prolonged enflurane and halothane anesthesia in volunteers.
		It is well established that methoxyflurane administration in man and Fischer 344 rats results in a dose-related renal concentrating defect by virtue of anesthetic metabolism to inorganic fluoride.
		Mazze Rl, Cousins NIJ, Kosek JC: Dose-related methoxyflurane nephrotoxicity in rats: A biochemical and pathologic correlation.
	www.slweb.org /mazze-nephrotoxicity.html (1511 words)

	NEJM -- Contrast nephrotoxicity: a randomized controlled trial of a nonionic and an ionic radiographic contrast agent
		To examine the relative nephrotoxicity of the two types of agents, we randomly assigned 443 patients to receive either iopamidol (nonionic) or diatrizoate (ionic) for cardiac catheterization.
		Nephrotoxicity was defined as an increase in the serum creatinine level within 48 hours of at least 44 mumol per liter.
		We were unable to demonstrate a difference in the incidence of nephrotoxicity between patients receiving a non-ionic contrast agent and those receiving an ionic contrast agent.
	content.nejm.org /cgi/content/abstract/320/3/149 (1027 words)

	EthyolÒ (Amifostine) for Injection
		Nephrotoxicity occurred in 49 (28%) patients in the amifostine arm and 87 (49%) patients in the control arm.
		When nephrotoxicity was analyzed by cycle (a secondary endpoint), the incidence was statistically significantly lower in the amifostine arm versus the control arm at the end of each cycle for cycles 1 through 5 (p<0.02) and over all cycles (p<0.001).
		Nephrotoxicity is defined as a 25% or more decrease from baseline in creatinine clearance at the completion of therapy.
	www.fda.gov /ohrms/dockets/ac/03/briefing/3936B1_05_MedImmune-Eythol.htm (3651 words)

	UIC College of Pharmacy Drug Information Center
		The incidence of contrast media induced nephrotoxicity is unknown, but has been estimated to occur in less than 1% of patients without significant risk factors.
		Fenoldopam has primarily been studied in patients at risk for development of contrast media induced nephrotoxicity and should therefore only be used in these high risk patients until further studies have been performed on fenoldopam's safety and efficacy in prevention of contrast media induced nephrotoxicity.
		Saline hydration remains the gold standard of therapy for prevention of contrast media induced nephrotoxicity and should be used in all patients regardless of use of fenoldopam.
	www.uic.edu /pharmacy/services/di/fenoldopam.htm (2035 words)

	Medline ® Abstract for Reference 8~9~13~14~15~16~17 of 'Pathogenesis, clinical features, and diagnosis of ...
		Contrast nephrotoxicity may be clinically important in patients with other factors simultaneously affecting the renal response to contrast or in whom acute renal failure would seriously affect prognosis.
		Knowledge of the pathogenetic pathways is accumulating and is leading to the discovery of rational specific prophylactic measures to reduce the burden of nephrotoxicity.
		Human radiocontrast nephrotoxicity is predicted by the presence of multiple risk factors, often associated with compromised renal circulation.
	www.utdol.com /application/abstract.asp?TR=renlfail/9576&viewAbs=8~9~13~14~15~16~17&title=8,9,13-17 (1133 words)

	[No title]
		Chronic kidney rejection and cyclosporine nephrotoxicity both injure the blood vessels of the kidney similarly, so the exact cause of the damage is difficult to distinguish after several years, Myers acknowledged.
		In chronic cyclosporine nephrotoxicity the principal injury is to the small arterioles where there is vacuolation of smooth muscle and endothelial cells [30].
		Although end-stage renal disease has been observed in up to 10% of cardiac transplant recipients, the risk for nephrotoxicity seems greatly lessened in patients with autoimmune disease who receive lower cyclosporine doses.
	www.lycos.com /info/cyclosporine--nephrotoxicity.html (311 words)

	HDCN: Review of article by Wissman et al. Acute cyclosporine-induced nephrotoxicity in renal transplant ...
		Cyclosporine nephrotoxicity continues to be a major factor in limiting its long term use.
		Animal studies suggest that nephrotoxicity is related to afferent arteriolar vasoconstriction mediated by a rise in intracellular calcium, a fall in vasodilatory prostaglandins or direct endothelial injury.
		The authors conclude that because the probability of this happening randomly is less than 5%, paired responses suggest the major effect of cyclosporin nephrotoxicity is mediated by the donor kidney rather than by host factors.
	www.hdcn.com /6/612jawis.htm (383 words)

	Nephrotoxicity of the Glutathione and Cysteine S-Conjugates of the Sevoflurane Degradation Product ...
		Commandeur, J. Oostendorp, R. Schoofs, P. Xu, B. and Vermeulen, N. Nephrotoxicity and hepatotoxicity of 1,1-dichloro-2,2-difluoroethylene in the rat.
		Dohn, D. Leininger, J. Lash, L. Quebbemann, A. and Anders, M. Nephrotoxicity of S-(2-chloro-1,1,2-trifluoroethyl)glutathione and S-(2-chloro-1,1,2-trifluoroethyl)-L-cysteine, the glutathione and cysteine conjugates of chlorotrifluoroethene.
		Finkelstein, M. Baggs, R. and Anders, M. Nephrotoxicity of the glutathione and cysteine conjugates of 2-bromo-2-chloro-1,1-difluoroethene.
	jpet.aspetjournals.org /cgi/content/full/283/3/1544 (3928 words)

	p981111a - Gentamycin, Nephrotoxicity
		Abstract: Aminoglycoside antibiotics maintain a leading role in antibacterial therapy of severe gram-negative infections despite nephrotoxicity complicating 10% to 20% of therapeutic courses.
		Second, trough levels reflect nephrotoxicity; the kidney is unable to excrete the dose of aminoglycoside within the dosing interval owing to impaired function.
		Further trials are warranted to establish specific guidelines for once-daily as well as every 36- to 48-hour dosing regimens in patients with established renal impairment for specific organisms and specific types of infection.
	www.emory.edu /WHSCL/grady/amreport/litsrch98/p981111a.html (289 words)

	BioMed Central \| Full text \| Peroxynitrite decomposition catalyst ameliorates renal damage and protein nitration in ...
		In addition, cisplatin-induced nephrotoxicity was evident by the histological damage of proximal tubular cells and by the increase in (a) serum creatinine, (b) blood urea nitrogen, and (c) urinary excretion of N-acetyl-β-D-glucosaminidase and total protein.
		The involvement of oxidative stress is further supported by the fact that the antioxidants melatonin [9] and vitamins C and E [5,10] prevent cisplatin-induced nephrotoxicity.
		Cisplatin in an effective chemotherapeutic agent for a wide variety of tumors, nevertheless, nephrotoxicity is the major complication of this antineoplasic treatment [1].
	www.biomedcentral.com /1471-2210/4/20 (3552 words)

	Tenofovir-related nephrotoxicity in HIV-infected patients
		This hypothesis is supported by animal studies, in which nephrotoxicity was the main TDF dose-limiting adverse event.
		This susceptibility of the kidney to the cytotoxic effect of nucleotides is caused by the high expression of human organic anion transporter 1 in kidney cells.
		Hypothetically, TDF nephrotoxicity in patients without any other predisposing factors might be genetically determined by a higher expression of this transporter.
	www.natap.org /2004/HIV/062804_09.htm (824 words)

	Nephrotoxicity - Biotrin International
		The Biotrin SMARTASSAYS nephrotoxicity biomarker comprise biomarkers for the proximal tubules, distal tubules, loop of Henle and collecting ducts, enabling a broad picture of renal injury to be obtained from a simple urine sample.
		The Biotrin SMARTASAAYS Nephrotoxicity Biomarkers comprise alpha GST, Pi GST/GSTYb1 and RPA-1 EIAs and RPA-1 and RPA-2 antisera.
		Commonly used tests for nephrotoxicity, e.g., serum creatinine and BUN may be inappropriate tests for nephrotoxicity monitoring, as they reflect compromised glomerular function, while most nephrotoxins tend to affect the renal tubules.
	www.biotrin.ie /Nephrotoxicity.html (951 words)

	UpToDate Pathogenesis and prevention of aminoglycoside nephrotoxicity and ototoxicity
		The main concerns with the use of aminoglycoside antibiotics are nephrotoxicity and ototoxicity.
		The uptake mechanism in the proximal tubule, which is mediated in part by polyanionic inositol phospholipids, megalin, or perhaps the N-methyl-D-asparate receptor [4], is saturable.
		In this limited population, gentamicin was more nephrotoxic, but the renal injury was mild with the plasma creatinine concentration remaining below 2 mg/dL (176 µmol/L) in almost all patients [3].
	patients.uptodate.com /topic.asp?file=renlfail/9988 (636 words)

	Cisplatin-Induced Nephrotoxicity in Porcine Proximal Tubular Cells: Mitochondrial Dysfunction by Inhibition of ...
		Cisplatin-Induced Nephrotoxicity in Porcine Proximal Tubular Cells: Mitochondrial Dysfunction by Inhibition of Complexes I to IV of the Respiratory Chain -- Kruidering et al.
		Sadzuka, Y., Shimizu, Y. and Takino, Y.: Role of glutathione S-transferase isoenzymes in cisplatin-induced nephrotoxicity in the rat.
		Zhang, J. and Lindup, W. Cisplatin nephrotoxicity: decreases in mitochondrial protein sulphydryl concentration and calcium uptake by mitochondria from rat renal cortical slices.
	jpet.aspetjournals.org /cgi/content/full/280/2/638 (6849 words)

	Laboratory guidelines for monitoring of antimicrobial drugs -- Hammett-Stabler and Johns 44 (5): 1129 -- Clinical ...
		protocol or as needed to assess nephrotoxicity (15)(20)(21)(22)(39)(41)(50)(51)(52).
		Comparative study of ototoxicity and nephrotoxicity in patients randomly assigned to treatment with amikacin or gentamicin.
		Nephrotoxicity of vancomycin, alone and with an aminoglycoside.
	www.clinchem.org /cgi/content/full/44/5/1129 (5638 words)

	Brazilian Journal of Infectious Diseases - Amphotericin B-related nephrotoxicity in low-risk patients (Site not responding. Last check: 2007-10-22)
		The glomerular filtration rate decreases due to renal vasoconstriction during drug infusion, and tubular dysfunction is a consequence of direct lesion of the cellular membrane due to interaction of the AmphoB molecule with cholesterol from the tubular cell membranes [3-6].
		Several studies published during the last two decades have shown that nephrotoxicity can be prevented by the use of sodium loading [4,7-11], slowing drug infusion [12] and through the use of liposomal or lipid-complex amphotericins [13-17].
		AmphoB-related nephrotoxicity is an important cause of morbidity, occurring to some degree in up to 80% of patients treated with this drug [1,2].
	www.scielo.br /scielo.php?script=sci_arttext&pid=S1413-86702006000200005 (3278 words)

	Apria - resources - News (Site not responding. Last check: 2007-10-22)
		Cisplatin (CP)-induced nephrotoxicity is associated with the increased generation of reactive oxygen metabolites and lipid peroxidation in kidney, caused by the decreased levels of antioxidants and antioxidant enzymes.
		The purpose of this study was to evaluate the role of Spirulina, blue-green alga with antioxidant properties, in the protection of cisplatin-induced nephrotoxicity in rat," investigators in Hyderabad, India report.
		Nephrotoxicity was assessed, 6 days after the CP treatment, by measuring plasma urea, creatinine, urinary N-acetyl-(D-glucose-aminidase) (beta-NAG) and histopathology of kidney.
	www.apria.com /resources/1,2725,494-559053,00.html (408 words)

	Aminoglycosides - Wheeless' Textbook of Orthopaedics
		Nephrotoxicity and ototoxicity of aztreonam versus aminoglycoside therapy in seriously ill nonneutropenic patients.
		A model for predicting nephrotoxicity in patients treated with aminoglycosides.
		Risk factors for nephrotoxicity in patients treated with aminoglycosides.
	www.wheelessonline.com /ortho/aminoglycosides (318 words)

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