Drug-related Kidney Injury and Safe Pharmacotherapy in the Elderly
Geneesmiddel gerelateerde nierschade en veilig geneesmiddelgebruik bij ouderen
The kidney performs two functions that are essential for life. First, it participates in the homeostasis of the extracellular environment that is required for adequate functioning of the cells. This is achieved by excretion of some of the waste products of metabolism and by specifically adjusting the urinary excretion of water and electrolytes to match net intake and endogenous production. Second, it secretes hormones that participate in the regulation of systemic and renal hemodynamics, red blood cell production, and bone metabolism. Many medicines have nephrotoxic potential, either by direct damage of tubular cells or by glomerular or interstitial damage following immune-complex formation. Well-known examples of nephrotoxicity include cytotoxic chemotherapeutic agents such as cisplatin and aminoglycoside antibiotics such as gentamycin. Despite the risk of nephrotoxicity, use of these drugs is justified in case no safer alternatives are available and if the underlying condition is more serious than the risk of renal damage. However, history provides several examples where these conditions were not met. Examples are the chronic nephropathy caused by non-steroidal anti-inflammatory drugs (NSAIDs) and related analgesics, most notably phenacetin, that was ultimately withdrawn in 1983, and the acute renal failure associated with lactic acidosis from phenformin that was ultimately withdrawn in 1976. A more recent example is the combined use of drugs affecting the renin-angiotensin system. In relation to this, the Pharmacovigilance Risk Assessment Committee (PRAC) issued a negative advice against combined use of these drugs in 2014.
|Keywords||renal diseases, kidney problems, drug use, urology|
|Promotor||B.H.Ch. Stricker (Bruno) , M.C.J.M. Sturkenboom (Miriam)|
|Publisher||Financial support for printing this thesis was generously provided by the Interdisciplinary Processing of Clinical Information (IPCI) group of the Department of Medical Informatics, Erasmus University Medical Center and the Dutch Evaluation Board|
van Blijderveen, J.C. (2014, December 9). Drug-related Kidney Injury and Safe Pharmacotherapy in the Elderly. Erasmus University Rotterdam. Retrieved from http://hdl.handle.net/1765/77463