Drug-Induced Nephrotoxicity

  • Mark H. Gardenswartz
  • Jan P. Goldberg
  • Robert W. Schrier


Physicians have become increasingly aware that the promise and potential of the current pharmacopeia is but one blade of a double-edged sword. Drug-induced disease is an alarming problem in every area of medical endeavor and indeed has had a major impact on the incidence, nature, and natural history of commonly encountered renal disease (Table 1). The broad array of modern nephrotoxins includes, among others, the penicillin homologues and antifungal, antiinflammatory, and antineoplastic agents. However, this introduction will concentrate on the two classes of drugs of greatest epidemiologic importance, i.e., radioiodinated contrast materials and aminoglycoside antibiotics.


Multiple Myeloma Acute Renal Failure Renal Insufficiency Antimicrob Agent Chronic Renal Insufficiency 
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  1. 1.
    Byrd L, Sherman RL: Radiocontrast-induced acute renal failure: A clinical and pathophysiologic review. Medicine 58:270, 1979.PubMedCrossRefGoogle Scholar
  2. 2.
    Shafi T, Chan SY, Porush JG, Shapiro W: Infusion intravenous pyelography and renal function. Effects in patients with chronic renal insufficiency. Arch Intern Med 138:1218, 1978.PubMedCrossRefGoogle Scholar
  3. 3.
    Vesely DL, Mintz DH: Acute renal failure in insulin-dependent diabetics. Episodes secondary to intravenous pyelography. Arch Intern Med 138:1858, 1978.PubMedCrossRefGoogle Scholar
  4. 4.
    Meeker TC, Ludwig S, Glimp R: Computerized axial tomography and acute renal failure. JAMA 240:2247, 1978.PubMedCrossRefGoogle Scholar
  5. 5.
    Heneghan M: Contrast-induced acute renal failure. Am J Roentgenol 131:1113, 1978.Google Scholar
  6. 6.
    Wagoner RD: Acute renal failure associated with contrast agents. Arch Intern Med 138:353, 1978.PubMedCrossRefGoogle Scholar
  7. 7.
    Brown M, Battle JD: Effect of urography on renal function in patients with multiple myeloma. Canad Med Assoc J 91:7–86, 1964.Google Scholar
  8. 8.
    Rees E, Waugh WH: Factors in renal failure in multiple myeloma. Arch Intern Med 116:400, 1965.PubMedCrossRefGoogle Scholar
  9. 9.
    Vix VA: Intravenous pyelography in multiple myeloma: A review of 52 studies in 40 patients. Radiology 87:896, 1966.PubMedGoogle Scholar
  10. 10.
    Morgan C Jr, Hammack WJ: Intravenous urography in multiple myeloma. N Engl J Med 275:77, 1966.PubMedCrossRefGoogle Scholar
  11. 11.
    Myers GH, Witten DM: Acute renal failure after excretory urography in multiple myeloma. Am J Roentgenol 113:583, 1971.Google Scholar
  12. 12.
    Schwartz WB, Hurwit A, Ettinger A: Intravenous urography in the patient with renal insufficiency. N Engl J Med 269:277, 1963.PubMedCrossRefGoogle Scholar
  13. 13.
    Ensor RD, Anderson EE, Robinson RR: Drip infusion urography in patients with renal disease. J Urol 103:267, 1970.PubMedGoogle Scholar
  14. 14.
    Alexander RD, Beckes SL, Abuelo JG: Contrast media-induced oliguric renal failure. Arch Intern Med 138:381, 1978.PubMedCrossRefGoogle Scholar
  15. 15.
    Ansari Z, Baldwin DS: Acute renal failure due to radiocontrast agents. Nephron 17:28, 1976.PubMedCrossRefGoogle Scholar
  16. 16.
    Carvallo A, Rakowski TA, Argy WP, Schreiner GE: Acute renal failure during drip infusion pyelography. Am J Med 65:38, 1975.CrossRefGoogle Scholar
  17. 17.
    Krumlovsky FA, Simon N, Santhanam S, de Greco F, Roxe D, Pomaranc MM: Acute renal failure—association with administration of radiographic contrast material. JAMA 239:125, 1978.PubMedCrossRefGoogle Scholar
  18. 18.
    Diaz-Buxo JA, Wagoner RD, Hattery RR, Palumbo PJ: Acute renal failure after excretory urography in diabetic patients. Ann Intern Med 83:155, 1975.PubMedGoogle Scholar
  19. 19.
    Harkonen S, Kjellstrand CM: Exacerbation of diabetic renal failure following intravenous pyelography. Am J Med 63:939, 1977.PubMedCrossRefGoogle Scholar
  20. 20.
    VanZee BE, Hay WE, Talley TE, Jaenike JR: Renal injury associated with intravenous pyelography in nondiabetic and diabetic patients. Ann Intern Med 89:51, 1978.PubMedGoogle Scholar
  21. 21.
    Weinrauch LA, Healy RW, Leland OS, Goldstein HH, Kassissieh SD, Libertino JA, Takacs FJ, D’Elia JA: Coronary angiography and acute renal failure in diabetic azotemic nephropathy. Ann Intern Med 86:56, 1977.PubMedGoogle Scholar
  22. 22.
    Pillary VKG, Robbins PC, Schwartz FD, Kark RM: Acute renal failure following intravenous urography in patients with long-standing diabetes mellitus and azotemia. Radiology 95:633, 1970.Google Scholar
  23. 23.
    Coggins C: Nephrotoxicity of radiographic contrast media in acute renal failure due to common pharmacologic agents in: American Society of Nephrology Symposium, Boston, 1979.Google Scholar
  24. 24.
    Gary NE, Buzzio L, Salaki J, Eisinger RP: Gentamicin-associated acute renal failure. Arch Intern Med 136:1101, 1976.PubMedCrossRefGoogle Scholar
  25. 25.
    Kosek JC, Mazze RI, Cousins MJ: Nephrotoxicity of gentamicin. Lab Invest 30:48, 1974.PubMedGoogle Scholar
  26. 26.
    Cronin RE: Aminoglycoside nephrotoxicity: Pathogenesis and prevention. Clin Nephrol 11:251, 1979.PubMedGoogle Scholar
  27. 27.
    Bennett WM, Plomp C, Porter GA: Drug-related syndromes. Ann Intern Med 87:582, 1977.PubMedGoogle Scholar
  28. 28.
    Anderson RJ, Linas SL, Berns AS, Henrich WL, Miller TR, Gabow PA, Schrier RW: Nonoliguric acute renal failure. N Engl J Med 296:1134, 1977.PubMedCrossRefGoogle Scholar
  29. 29.
    Brinker K, Cronin R, Bulger R, Southern P, Henrich W: Potassium (K) depletion: Risk factor for and consequence of gentamicin (G) nephrotoxicity in: American Society of Nephrology Symposium, Boston, 1979. p 79A (abstract).Google Scholar
  30. 30.
    Baylis C, Rennke HR, Brenner BM: Mechanisms of the defect in glomerular ultrafiltration associated with gentamicin administration. Kidney Int 12:344, 1977.PubMedCrossRefGoogle Scholar
  31. 31.
    Kunin CM: Binding of antibiotics to tissue homogenates. J Infect Dis 121:55, 1970.PubMedCrossRefGoogle Scholar
  32. 32.
    Luft FC, Kleit SA: Renal parenchymal accumulation of aminoglycoside antibiotics in rats. J Infect Dis 130:656, 1974.PubMedCrossRefGoogle Scholar
  33. 33.
    Luft FC, Yum MN, Kleit SA: Comparative nephrotoxicities of netilmicin and gentamicin in rats. Antimicrob Agents Chemother 10:845, 1976.PubMedGoogle Scholar
  34. 34.
    Kaloyanides GJ, Bowman R, Silverblatt F: Effect of gentamicin and netilmicin on renal function in the rat. Clin Res 25:138A, 1977 (abstract).Google Scholar
  35. 35.
    Bennett WM, Hartnett MN, Gilbert D, Houghton D, Porter GA: Effect of sodium intake on gentamicin nephrotoxicity in the rat. Proc Soc Exp Biol Med 151:736, 1976.PubMedGoogle Scholar
  36. 36.
    Appel GB, Neu HC: The nephrotoxicity of antimicrobial agents. N Engl J Med 296:722, 1977 (second of three parts).PubMedCrossRefGoogle Scholar
  37. 37.
    Bar RS, Wilson HE, Mazzafein EL: Hypomagnesemic hypocalcemia secondary to renal magnesium wasting: A possible consequence of high dose gentamicin therapy. Ann Intern Med 82:646, 1975.PubMedGoogle Scholar
  38. 38.
    Holmes AM, Hesling CM, Wilson TM: Drug induced secondary hyperaldosteronism in patients with pulmonary tuberculosis. Quart J Med 39:299, 1970.PubMedGoogle Scholar
  39. 39.
    Hewlitt WL: Gentamicin: Toxicity in perspective. Postgrad Med J 50(suppl 7):55, 1974.Google Scholar
  40. 40.
    Schrier RW: Acute renal failure. Kidney Int 15:205, 1979.PubMedCrossRefGoogle Scholar
  41. 41.
    Lane AZ, Wright GE, Blair DC: Ototoxicity and nephrotoxicity of amikacin, in: Proceedings of the U.S. Amikacin Symposium, University of California Medical School, Los Angeles, Nov. 9–10, 1976. Am J Med 62:911, 1977.PubMedCrossRefGoogle Scholar
  42. 42.
    Lawson DH, Macadam RF, Singh H, Gavras H, Hartz S, Turnbull D, Linton AL: Effect of furosemide on antibiotic-induced renal damage in rats. J Infect Dis 126:593, 1972.PubMedCrossRefGoogle Scholar
  43. 43.
    Dellinger P, Murphy T, Pinn V, Barza M, Weinstein L: The protective effect of cephalothin against gentamicin-induced nephrotoxicity in rats. Antimicrob Agents Chemother 9:172, 1976.PubMedGoogle Scholar
  44. 44.
    Harrison WO, Silverblatt FJ, Turck M: Gentamicin nephrotoxicity: Failure of three cephalosporins to potentiate injury in rats. Antimicrob Agents Chemother 8:209, 1975.PubMedGoogle Scholar
  45. 45.
    Wade JC, Petty BG, Conrad G, Smith CR, Wade JC, Petty BG, Conrad G, Smith CR, Lipsky JJ, Ellner J, and Leitman P: Cephalothin plus an aminoglycoside is more nephrotoxic than methicillin plus an aminoglycoside. Lancet 2:604, 1978.PubMedCrossRefGoogle Scholar
  46. 46.
    Klastersky J, Hensgens C, Debusscher L: Empiric therapy for cancer patients: Comparative study of ticarcillin-tobramycin, ticarcillin-cephalothin, and cephalothin-tobramycin. Antimicrob Agents Chemother 7:640, 1975.PubMedGoogle Scholar
  47. 47.
    Dahlgren JG, Anderson ET, Hewitt WL: Gentamicin blood levels: A guide to nephrotoxicity. Antimicrob Agents Chemother 8:58, 1975.PubMedGoogle Scholar
  48. 48.
    Plomp C, Bennett W, Gilbert D, Porter G: The effect of dosage regimen on experimental gentamicin nephrotoxicity: Dissociation of peak serum levels from renal failure. Clin Res 26:125A, 1978 (abstract).Google Scholar
  49. 49.
    Adelman RD, Counzelman G, Spangle W, Ishizaki G: Enzymes: An early sign of gentamicin nephrotoxicity. Kidney Int 10:493A, 1976.Google Scholar
  50. 50.
    Bennett WM: American Society of Nephrology Symposium, Boston, 1979.Google Scholar
  51. 51.
    Levinsky NG, Alexander EA: Acute renal failure, in: Brenner BM, Rector FC (eds): The Kidney, Vol 2. Philadelphia, W. B. Saunders, 1976, p 806.Google Scholar
  52. 52.
    McMurray SD, Luft FC, Maxwell DR, Hamburger RJ, et al: Prevailing patterns and predictor variables in patients with acute tubular necrosis. Arch Intern Med 138:950, 1978.PubMedCrossRefGoogle Scholar
  53. 53.
    Galpin JE, Shinaberger JH, Stankey TM, Blumenkrantz MJ, et al: Acute interstitial nephritis due to methicillen. Am J Med 65:756, 1978.PubMedCrossRefGoogle Scholar
  54. 54.
    Metys R, Hornych A, Burianova B, Jirka J: Influence of triiodinated contrast media on renal function. Nephron 8:559, 1971.PubMedCrossRefGoogle Scholar
  55. 55.
    Reiss MD, Bookstein JJ, Bleifer KH: Radiology aspects of renovascular hypertension. JAMA 221:375, 1972.PubMedCrossRefGoogle Scholar
  56. 56.
    Port FK, Wagoner RD, Fulton RE: Acute renal failure after angiography. Am J Roentgenol 121:544, 1974.Google Scholar
  57. 57.
    Older RA, Miller JP, Jackson DC, Johnsrude IS, Thompson, WM: Angiographically induced renal failure and its radiographic detection. Am J Roentgenol 126:1039, 1976.Google Scholar
  58. 58.
    Swartz R, Rubin J, Leeming B, Silva P: Renal failure following major angiography. Am J Med 65:31, 1978.PubMedCrossRefGoogle Scholar
  59. 59.
    European Organization for Research on Treatment of Cancer (EORTC): Three antibiotic regimens in the treatment of infection in febrile granulocytopenic patients with cancer. J Inf Dis 137:14, 1978.CrossRefGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1985

Authors and Affiliations

  • Mark H. Gardenswartz
    • 1
  • Jan P. Goldberg
    • 1
  • Robert W. Schrier
    • 1
  1. 1.Department of MedicineUniversity of Colorado Health Sciences CenterDenverUSA

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