Nephrotoxic drugs are pharmacotherapies that can lead to a decline in renal function. The drug may need to be discontinued, or the dosing reduced when this happens.

• Acetaminophen
• Aspirin
• H1 antagonist
• Cephalosporins
• Cocaine
• Diuretics
• NSAIDs
• Penicillins
• Proton pump inhibitors
• Angiotensin converting enzyme inhibitors
• Statins

• Aminoglycosides (10-15% Incidence of acute tubular necrosis)

• Occurs in 10-20% patients on 7 day course
• Results in non-oligurics; increased creatinine
• A single dose early in septic course is usually safe

• Amphotericin B (Incidence 80-90%)
• Ciprofloxacin
• Chloroquine
• Erythromycin
• Gentamycin
• Hydroxychloroquine
• Isoniazide
• Levofloxacin
• Methicillin
• Rifampin
• Sulfonamides
• Tetracycline
• Trimethadione
• Vancomycin

• Acyclovir (only nephrotoxic in intravenous form)
• Adefovir
• Cidofovir
• Foscarnet
• Indinavir
• Tenofovir

• Chloroquine
• Hydroxychloroquine
• Pentamidine
• Quinine

• Cisplatin
• Cyclosporine
• Interferon alpha
• Methotrexate
• Mitomycin
• Foscarnet
• Tacrolimus

• Arsenic poisoning
• Bismuth
• Gold therapy
• Lead poisoning
• Lithium related kidney disorders

• Polydipsia and nephrogenic diabetes insipidus
• Acute renal failure

  • Dialysis indications: serum creatinine >2.5 or seizures, rhabdomyolysis

• Chronic kidney disease with fibrosis

• Mercury poisoning
• Nitrosourea compounds

• Fenofibrate (Tricor)

• Increases serum creatinine without significant decrease in GFR
• Serum creatinine rise is reversible on stopping fenofibrate

• Gemfibrozil

• Associated with acute renal failure due to rhabdomyolysis

• Statins

• Carmustine
• Carboplatin
• Cisplatin
• Ifosfamide

• Causes fanconi’s syndrome

• Lomustine

• Esomeprazole
• Lansoprazole
• Omeprazole
• Pantoprazole
• Rabeprazole

• Chronic stimulant laxative use

• Resulting chronic volume depletion and hypokalemia causes nephropathy

• Radiocontrast agents
• ACE Inhibitors

• Expect an increase of serum creatinine in chronic kidney disease

• Acetaminophen
• Amitriptyline
• Anticoagulants
• Allopurinol
• Aspirin

• Low dose aspirin reduces renal function in elderly

  • Decreased creatinine clearance after 2 weeks of use
  • Changes persisted for at least 3 weeks off aspirin

• Aristocholic acid containing Chinese herbals
• Bevacizumab
• Carbon tetrachloride
• Cimetidine
• Ciprofloxacin
• Clopidogrel
• Dilantin
• Diuretics

• Thiazides
• Furosemide
• Triamterene

• Doxepin
• Fluoxetine
• H1 antagonists

• Diphenhydramine
• Doxylamine

• Infliximab
• Interferons
• Mesalamine (Asacol, Pentasa)

• Mesalamine is an NSAID analog and has systemic absorption from the bowel

• NSAIDs: celecoxib, ibuprofen, naproxen

• Nephrotic syndrome type reaction

• Penicillins and cephalosporins
• Pamidronate
• Propylthiouracil

• Hypersensitivity (fever, rash, arthralgia)

• Rifampin
• Sulfonamides

• Vasculitis reaction

• Ticlopidine
• Zoledronate

• Cocaine
• Heroin
• Ketamine
• Methadone
• Methamphetamine

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