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Skip to 0 minutes and 11 seconds Contrast media and contrast media is actually very easy to cause nephrotoxicity especially in a patient with diabetes. So those patient when they come to use to do contrast media exam including some MRI or something that we need to closely look at those image. And others time pharmacist need always to remember that we have to instruct or ensure the patient if they still with metformin. Metformin as one of medication that you do not want to have during patient with radio-contrast media. Because actually metforin has the side effect for lactic acidosis which may contribute to radio-contrast media induced nephrotoxicity.

Skip to 1 minute and 23 seconds so very important to check those patient with diabetes and also risk factor includes volume depletion so having hydration is important and of course for patient with heart failure because they have an issue of a volume depletion. So as easier for them to encounter contrast media induce nephrotoxicity and so giving half-saline forward enough hours that’s very important. ACE inhibitor, and we all know that ACE inhibitor is very important for patient with diabetics and hypertension to use ACE inhibitor. But however when a patient has renal artery stenosis or those patient with bad renal function you need to avoid ACE inhibitor in such a situation. And so we actually need to check when we start ACE inhibitor and also monitor the patient’s potassium.

Skip to 2 minutes and 44 seconds And the treatment includes discontinue ACE inhibitor and also to the patients hyperkalemia. So those are very important and if some patient actually serve as those ACE inhibitor. There are some protocol for you to use such as a captopril renoprogram. NSAID NSAID is also one of a group of madication with high incidence of nephrotoxicity And usually for both patient with high plasma renin activities or patient administrating with diuretic therapy. Or those are patient is the encounter issue of a nephrotoxicity. So the prevention is actually to avoid use in some high-risk patient. And if you have to use that choosing some medication with less accidence of nephrotoxicity as necessary. For example sulindac.

Skip to 4 minutes and 2 seconds And the treatment for NSAID induce nephrotoxicity includes supportive care actually. And for those who has diagnosed with acute interstitial nephritis steroids as one of the drug therapy.

Risk Factors & Prevention for radio contrast media, ACEI, and NSAID

Continuing from the previous step, Prof. Chen demonstrates the major medications which cause nephrotoxicity notable this time.

The first one is radio-contrast media. Since metformin has the side effect for lactic acidosis which may contribute to radio-contrast media induced nephrotoxicity, you will not dose it during the period when a patient is using radio-contrast media.

Also, the risk factors of radio-contrast media include diabetic nephropathy. Thus, patients with diabetes should use it very carefully.

The second one is ACE inhibitor, and the main risk factor is renal efferent arteriolar constriction.

The third one is NSAID. However, we can use some NSAID to prevent the nephrotoxicity, such as Sulindac.

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Pharmacokinetics: Drug Dosing in Renal Disease

Taipei Medical University