3Acute toxic renal failure
Section snippets
Myoglobinuria
Rhabdomyolysis is the breakdown of striated muscle with release of constitutive components into the extracellular fluid and circulation. One of the key compounds released is myoglobin, an 18.8 kDa oxygen carrier. Normally, myoglobin is loosely bound to plasma globulins and only small amounts reach the urine. When massive amounts of myoglobin are released, the binding capacity of plasma protein is exceeded. Myoglobin is then filtered by the glomeruli and subsequently reaches the tubules.12
Radiocontrast nephropathy
Within the last decade, radiological procedures utilizing contrast media are being widely applied for both diagnostic and treatment purposes. This has resulted in an increasing incidence of renal function impairment caused by the exposure to contrast material—an iatrogenic disorder known as radiocontrast nephropathy (RCN). Acute RCN is the third leading cause of new-onset renal failure in hospitalized patients. RCN is associated with prolonged in-hospital stay, increased morbidity, mortality,
Conclusion
Toxic nephropathy should always be considered as a cause of ARF in surgical patients. Both exo-and endotoxins may be involved. Awareness of the range of toxins and the high-risk clinical settings in which they become important is vital in avoiding toxic ARF and in minimizing its clinical severity. Simple prophylactic measures include therapeutic drug monitoring, avoidance of concomitant use of several potentially nephrotoxic drugs and restoration/maintenance of adequate hydration (Table 3).
Acknowledgements
The author thanks Dirk Kuypers, MD, for his helpful comments and suggestions.
References (92)
- et al.
Mechanisms of acute renal failure
British Journal of Anaesthesia
(1996) - et al.
Acute renal failure associated with cardiac operations. A case-control study
Journal of Thoracic and Cardiovascular Surgery
(1989) - et al.
Postoperative acute renal failure secondary to rhabdomyolysis from exaggerated lithothomy position
Journal of Clinical Anesthesia
(1999) - et al.
Oxygen free radicals and contrast nephropathy
American Journal of Kidney Diseases
(1998) Contrast-medium-induced acute renal failure
Kidney International
(1998)- et al.
Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a radomized trial
Kidney International
(1995) - et al.
A prospective randomized trial of prevention measures in patients a high risk for contrast nephropathy
Journal of the American College of Cardiology
(1999) - et al.
Prophylactic hemodialysis after radiocontrast media in patients with renal insufficiency is potentially harmfull
American Journal of Medicine
(2001) - et al.
Preoperative assessment and perioperative management of the patient with nonischemic heart disease
Medical Clinics of North America
(2003) - et al.
The clinical significance of inhibition of renal prostaglandin synthesis
Kidney International
(1987)
Are selective COX-2 inhibitors nephrotoxic?
American Journal of Kidney Diseases
Aminoglycoside nephrotoxicity
Kidney International
Once versus thrice daily gentamicin in patients with serious infections
Lancet
Risk factors for amphotericin B-associated nephrotoxicity
American Journal of Medicine
Crystal-induced acute renal failure
American Journal of Medicine
Toxicity of anaesthetics
Best Practice Research Clinical Anaesthesiology
Halogenated inhalational anesthetics
Best Practice and Research Clinical Anaesthesiology
Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study
Lancet
Prevention of acute renal failure in the critically III
American Journal of Respiratory and Critical Care Medicine
Acute renal failure in the surgical setting
Australian and New Zealand Journal of Surgery
Acute renal failure following cardiac surgery?
Nephrology Dialysis Transplantation
Perioperative care of the renal patient
Archives Internal Medicine
Association of preoperative risk factors with postoperative acute renal failure
Anesthesia and Analgesia
Preoperative renal risk stratification
Circulation
The effect of acute renal failure on mortality. A cohort analysis
Journal of the American Medical Association
Survivors of acute renal failure who do not recover renal function
Quarterly Journal of Medicine
and the Madrid Acute Renal Failure Study Group. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group
Kidney International
Journal of the American Society of Nephrology
Causes of acute renal failure
Compartment syndrome, rhabdomyolysis and risk of acute renal failure as complications of the lithotomy position
Journal of Nephrology
Traumatic rhabdomyolysis resulting from continuous compression in the exaggerated lithotomy position for radical perineal prostatectomy
International Journal of Urology
Rhabdomyolysis following cardiopulmonary bypass and treatment with enoximone in a patient susceptible to malignant hyperthermia
Anesthesiology
Delayed postoperative rhabdomyolysis in a patient subsequently diagnosed as malignant hyperthermia susceptible
Anesthesiology
A fatal case of malignant hyperthermia complicated by generalized compartment syndrome and rhabdomyolysis
Acta Anaesthesiologica Scandinavica
Oxidant mechanisms in toxic acute renal failure
Drug Metabolism Reviews
Continuous veno-venous hemofiltration for the immediate management of massive rhabdomyolysis after fulminant malignant hyperthermia in a bodybuilder
Anesthesiology
Clinical presentation of haemolytic transfusion reactions
Anaesthesia and Intensive Care
Haemolysis following implantation of duct occlusion coils
Heart
Radiocontrast nephropathy: identifying the high-risk patient and the implications of exacerbating renal function
Reviews in Cardiovascular Medicine
Contrast media-associated nephrotoxicity
Seminars in Nephrology
Contrast media-associated nephrotoxicity
Current Opinion in Nephrology and Hypertension
Role for intrarenal adenosine in the renal hemodynamic response to contrast media
Journal of Laboratory and Clinical Medicine
nephropathy Journal of the American Society of Nephrology
Protection from the nephrotoxicity of contrast dye
Renal Failure
Multiple myeloma and contrast media
Radiology
Nephrotoxic effects in high-risk patients undergoing angiography
New England Journal of Medicine
Cited by (56)
International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): A human rights case for nephrology
2015, The LancetCitation Excerpt :Some of the recommendations rely on the availability of blood chemistry analysers, which might have little or no availability in resource-limited settings, particularly in those in level 2 and 3 countries. The avoidance of drugs and nephrotoxins that cause AKI138,139 and appropriate dose adjustment of renally cleared or protein-bound drugs140 are essential. Drugs that should be used with caution or avoided include angiotensin-converting-enzyme inhibitors, angiotensin-II receptor blockers, NSAIDs,141–144 aminoglycosides,145,146 amphotericin B,146 contrast media, chemotherapy drugs,147,148 antiretroviral therapy, and calcineurin blockers.
Nephrotoxicity and Nephroprotective Potential of African Medicinal Plants
2014, Toxicological Survey of African Medicinal PlantsSelective ET<inf>A</inf> receptor blockade protects against cisplatin-induced acute renal failure in male rats
2014, European Journal of PharmacologyCitation Excerpt :Results of the current study demonstrated that acute administration of cisplatin (6 mg/kg) to male rats led to histological alterations of the renal tubular cells. These changes were associated with decline in renal functions, leading to increased concentrations of serum creatinine and blood urea nitrogen, and are in line with previous studies (Evenepoel, 2004; Lameire et al., 2005; Sahu et al., 2013). Furthermore, the findings of the current study point to the presence of oxidative stress and are in accordance with data in previous reports (Antunes et al., 2001; Mora et al., 2003; Sahu et al., 2013; Weijl et al., 1997).
Drug induced nephrotoxicity and associated factors a narrative review
2023, Journal of Medical Pharmaceutical and Allied SciencesEvaluation of Acute Kidney Injuries Among Acutely Intoxicated Patients by RIFLE Classification
2022, Mansoura Journal of Forensic Medicine and Clinical Toxicology