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Skip to 0 minutes and 11 seconds And let’s review some of our major medications as cause nephrotoxicity The top of the lists is aminoglycoside. As everyone knows aminoglycoside as one of the antibiotics that viruses need to make their recommendation about dosing And actually, Dr. Charles Lee in his previous lecture has mentioned a lots about dose medications. So, hereby, I quickly review those risk factors are for drug induced toxicity. Risk factor for causing aminoglycoside nephrotoxicity includes patients own risk factor, or aminoglycoside risk factor such as prolonged dose or high dose or concurrent with some nephrotoxic drugs. It’s the direct toxin to renal tubules so the patient will actually develop those nonoliguria.

Skip to 1 minute and 18 seconds And patient may have may get magnesium and potassium waste And usually luckily is aminoglycoside nephrotoxicity is reversible. So after good checking of the blood level and give enough hydration and that kidney will recover. So that’s very important that pharmacists need to check those patients who are on aminoglycoside if they already taking those two dosing of aminoglycoside including gentamicin and amikacin and provide well hydration with limited total dose. Cyclosporine This is a very important Immunosuppressant used for transplant patients. And it’s very difficult to differentiate cyclosporine-induced nephrotoxicity and the patient if they develop rejection. So clinically we need to monitor cyclosporine level and also check those patients signs and symptoms.

Skip to 2 minutes and 39 seconds and if need the patient may actually undergo fine-needle renal biopsy to see if they have a renal rejection or if they have a high level of cyclosporine which actually indeed indicate the patient has cypclosporin-induced nephrotoxicity. and actually, when a patient actually transplanting patients may actually has a low, you know immunoprotection. so they may actually treated with acyclovir or ketoconazole. Or sometimes if the patient develop fungal infection amphotericin B or some other medications used for infection they could actually increase the rate of a cyclosporine nephrotoxicity. And prevention for cyclosporine nephrotoxicity actually that’s monitoring is a top of the last. and we don’t actually has very useful method to prevent cyclosporine level and several toxicity.

Skip to 3 minutes and 52 seconds Okay for amphotericin B and amphotericin B sometimes we call “amphoterrible” because it’s very easy to induce a nephrotoxicity in patient. And risk factor includes high baseline serum creatinine and high cumulative dose and some patient may have a rapid infusion and cause of amphotericin B induced nephrotoxicity. so it may become irreversible. so it’s very important that patient need to have enough hydration and full salt diet and using the liposomal form of amphotericin B can actually reduce the incidence of amphotericin B nephrotoxicity.

Risk Factors & Prevention for AMG, Cyclosporine, and Amphotericin B

In this step, Prof. Chen introduces three major medications, which cause nephrotoxicity notable.

The first one is aminoglycoside. The risk factors include concurrent nephrotoxic drugs. Thus, we can do well hydration, limit total dose, or monitor PK to prevent this nephrotoxicity.

The second one is Cyclosporine, an important immunosuppressant used for transplant patients. It is difficult to differentiate cyclosporine-induced nephrotoxicity and allograft rejection. Therefore, we need to monitor cyclosporine level and check the signs and symptoms clinically.

The final one is Amphotericin B, and the risk factors include baseline renal function, cumulative dose, diuretics, and rapid infusion.

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Pharmacokinetics: Drug Dosing in Renal Disease

Taipei Medical University