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Medication-Induced Kidney Injury for the Primary Care Pediatrician

  • Pediatric Nephrology (BP Dixon and E Nehus, Section Editors)
  • Published:
Current Treatment Options in Pediatrics Aims and scope Submit manuscript

Abstract

Purpose of review

Medication-induced kidney injury is one of the most common causes of acute kidney injury (AKI); however, it is often under-recognized. The purpose of this review is to aid providers to recognize patterns of kidney injury induced by specific nephrotoxic agents that are used in ambulatory care and the identification of children at high risk of these complications.

Recent findings

Acute kidney injury prevention by nephrotoxic medication avoidance has been advanced greatly by the NINJA (Nephrotoxin Injury Negated by Just in Time Action) project. This work in the inpatient setting has led to a better understanding of the true incidence of nephrotoxicity-associated AKI as well as the ability to avoid this complication. While this work was performed in the inpatient setting, the knowledge gained has helped to shed light on the potential improvements in outcomes with more thoughtful prescribing.

Additionally, ongoing work on sub-phenotype patterns of nephrotoxic kidney injury has enhanced diagnostic capabilities and thus led to an earlier withdrawal of offending agents. An understanding of the common biologic mechanisms by which medications cause injury, and thus the expected clinical phenotypes, has helped providers detect and manage AKI associated with nephrotoxic agents.

Summary

AKI is a common clinical problem with a wide range of potentially serious sequelae. Nephrotoxic medication exposure is one of the leading contributors to acute kidney injury in children, particularly when combined with additional risk factors. AKI is not an inevitable complication of medical illness and therapy and, in the right clinical context, can be avoided.

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Funding

No funding was received for the preparation of this review.

Author information

Authors and Affiliations

  1. Division of Nephrology, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA

    Amy Strong MD, MSCE

  2. Division of Paediatric Nephrology, Women’s and Children’s Hospital, Adelaide, Australia

    Rachael Kermond MBBS

  3. Department of Paediatrics, Federal Medical Centre Yenagoa, Yenagoa, Bayelsa State, Nigeria

    Evi Joboy-Okei MBBS, MPH, FMCPaed

  4. Department of Pediatrics, All India Institute of Medical Sciences, Patna, India

    Swarnim MBBS, MD

  5. Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children’s Hospital, 1280 Main St W, Hamilton, ON, L8N 3Z5, Canada

    Rahul Chanchlani MD, MSc, FASN, FRCPC

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  1. Amy Strong MD, MSCE
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  2. Rachael Kermond MBBS
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  3. Evi Joboy-Okei MBBS, MPH, FMCPaed
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  4. Swarnim MBBS, MD
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  5. Rahul Chanchlani MD, MSc, FASN, FRCPC
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Contributions

AS wrote the outline of the text as well as multiple sections. SS, EJ-O, and RK wrote multiple sections of the text. All authors reviewed and finalized the manuscript.

Corresponding author

Correspondence to Rahul Chanchlani MD, MSc, FASN, FRCPC.

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Amy Strong declares that she has no conflict of interest. Rachael Kermond declares that she has no conflict of interest. Evi Joboy-Okei declares that they have no conflict of interest, Swarnim Swarnim declares that she has no conflict of interest. Rahul Chanchlani declares that he has no conflict of interest.

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Strong, A., Kermond, R., Joboy-Okei, E. et al. Medication-Induced Kidney Injury for the Primary Care Pediatrician. Curr Treat Options Peds 9, 314–327 (2023). https://doi.org/10.1007/s40746-023-00290-1

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