MANAGEMENT AND PREVENTION OF DRUGS INDUCED END STAGE RENAL DISEASE

Abstract

Under normal conditions each of the two million nephrons of the kidney works in an organized approach to filter, reabsorb, and excrete various solutes and water. The kidney is a primary regulator of sodium and water as well as acid-base homeostasis. The kidney also produces hormones necessary for red blood cell synthesis and calcium homeostasis. Impairment of normal kidney function is often referred to as renal insufficiency. Based on the time course of development, renal insufficiency has historically been divided into two broad categories. Acute renal failure (ARF) refers to the rapid loss of renal function over days to weeks. Chronic kidney disease (CKD), also called chronic renal insufficiency (CRI) by some, is defined as a progressive loss of function occurring over several months to years, and is characterized by the gradual replacement of normal kidney architecture with interstitial fibrosis. Progressive kidney disease or nephropathy is generally synonymous with CKD, and the two phrases are often used interchangeably. The working group of the National Kidney Foundation’s Kidney Dialysis Outcomes and Quality Initiative (K/DOQI) has recently developed a new scheme to classify CKD based on the presence of kidney damage, structural or functional, for ≥3 months, with or without decreased glomerular filtration rate (GFR) from normal values of approx.120 mL/min. CKD is further categorized by the level of kidney function (as defined by GFR) into stages 1 through 5.1 Although these stages are defined later in this review, it is necessary to denote at this point that Stage 5 was previously referred to as End-Stage Renal Disease (ESRD) or End-Stage Kidney Disease (ESKD). The aim of this review article is to focus on the medical therapies which induce nephrotoxicity.