Drugs and other chemicals damage the kidney by:
1. Direct biochemical effect Substances that cause direct toxicity include:
• Antimicrobials, e.g. aminoglycosides, amphotericin, cephalosporins
• Iodinated radiological contrast media, e.g. agents for visualising the biliary tract
• Analgesics, e.g. NSAID combinations and paracetamol (actually its metabolite, NABQI, in overdose, see p. 287)
• Solvents, e.g. carbon tetrachloride, ethylene glycol.
2. Indirect biochemical effect
• Cytotoxic drugs and uricosurics may cause urate to be precipitated in the tubule.
• Calciferol may cause renal calcification by causing hypercalcaemia.
• Diuretic and laxative abuse can cause tubule damage secondary to potassium and sodium depletion.
• Anticoagulants may cause haemmorrhage into the kidney.
3. Immunological effect A wide range of drugs produces a wide range of injuries.
• Drugs include: phenytoin, gold, penicillins, hydralazine, isoniazid, rifampicin, penicillamine, probenecid, sulphonamides.
• Injuries include: arteritis, glomerulitis, interstitial nephritis, systemic lupus erythematosus.
A drug may cause damage by more than one of the above mechanisms, e.g. gold. The sites and pathological types of injury are as follows:
Glomerular damage. The large surface area of the glomerular capillaries renders them susceptible to damage from circulating immune complexes; glomerulonephritis, proteinuria and nephrotic syndrome may result, e.g. following treatment with
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