Drug-induced prerenal acute kidney injury

• Autor(a) principal: Santos, Luís Pedro Amaral
• Data de Publicação: 2019
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.6/8710
• topic: Anti-Inflamatórios Não Esteróides; Diuréticos; Inibidores do Sistema Renina-Angiotensina; Lesão Renal Aguda; Nefrotoxicidade; Domínio/Área Científica::Ciências Médicas::Ciências da Saúde::Medicina

Acute kidney injury is a heterogeneous disorder that is common in hospitalized patients and associated with short- and long-term morbidity and mortality, as well high healthcare costs. It is defined as a rapid decrease in the glomerular filtration rate, occurring over a period of hours to days and by the inability of the kidney to regulate fluid and electrolyte homeostasis appropriately. Approximately 70% of community-acquired cases of acute kidney injury are attributed to prerenal causes, which include severe hypotension, sepsis, dehydration, heart failure, liver failure, narrowing of renal arteries and exposure to a large number of drugs. Prerenal acute kidney injury results from glomerular hemodynamic alterations leading to reduced glomerular filtration rate with no parenchymal compromise. Autoregulatory mechanisms can partially compensate renal perfusion reduction in order to maintain glomerular filtration rate. Non-steroidal anti-inflammatory drugs, renin-angiotensin system inhibitors and diuretics - a combination also known as “triple whammy” - can reduce the glomerular filtration rate and lead to prerenal acute kidney injury. A number of different mechanisms are involved, including inhibition of both prostaglandin-mediated control of glomerular afferent arteriolar tone and angiotensin control of efferent arteriolar tone, as well as volume depletion, all contributing to reduced renal plasma flow. This literature review intends to systematize the different pathophysiological mechanisms by which the different drugs promote prerenal acute kidney injury and, on the other hand, to compare the different groups of drugs in relation to their potential to induce prerenal acute kidney injury.