Drugs That Can Cause Kidney Failure

When your kidneys lose their ability to filter your body's blood, you are said to be in kidney failure. This can happen quickly (called acute renal failure) or gradually over time (called chronic real failure). Some medications and drugs can cause acute kidney failure such as non-steroidal anti-inflammatory drugs (NSAIDs), some medications used to treat high blood pressure and specific types of antibiotics. In some patients, the dye used in radiologic procedures can also cause kidney failure. Although these substances are very useful and safe and kidney failure will not occur in most people using these medications, some people may be at higher risk.

NSAIDs

• NSAIDs interfere with the production of prostaglandin, a substance that plays a role in allowing enough blood to get to the kidneys; less prostaglandin means less blood flow. This lack of blood can cause the kidneys to stop working effectively. Patients who are taking high doses of NSAIDs, patients who already have some kidney problems or older people are at higher risk for kidney failure caused by NSAIDs. People who take medications like diuretics can also be at risk for kidney problems while taking NSAIDs. These people should discuss any use of over-the-counter NSAIDs with a physician.

ACE Inhibitors and Angiotensin II Receptor Blockers

• ACE inhibitors and angiotensin II receptor blockers (ARBs) are classes of medications often used to treat high blood pressure. Both actually have benefits for people with chronic kidney disease; however, the medications need to be started at low doses with frequent blood testing to monitor kidney function. A mild reduction in kidney function is expected when one of these agents is first initiated, but if the decrease is greater than 30 percent of baseline, the agent should be discontinued and administered at a lower dose if restarted. To avoid further risk of kidney failure, patients who are taking ACE inhibitors and ARBs should avoid NSAID medications and dehydration.

Aminoglycoside Antibiotics

• Aminoglycoside antibiotics are useful in treating specific bacterial infections But in 10 percent to 20 percent of patients, these agents can cause kidney failure. Patients who are most at risk for kidney failure after using aminoglycosides are people who receive a large dose or have to be treated for a long time; patients who are taking other medications that can cause kidney problems, and patients who are very ill. Kidney issues are usually seen within seven days of starting treatment.

Radiocontrast Dye

• Patients who have other health problems such as diabetes combined with kidney disease may be at higher risk for kidney failure after a radiologic procedure that uses contrast dye. Patients who receive large amounts of dye or who suffer from dehydration can also develop kidney failure after a procedure. As with other medications and agents that can cause kidney failure, there is often an initial decrease in kidney function that stabilizes over a few days, but in patients with previous risk factors, this may not improve. Adequate fluid intake and the use of newer types of contrast agents can lower this risk.

Other Drugs

• In patients who are at high risk for kidney problems, several other medications can cause problems. Diuretics taken alone can cause dehydration which can lead to kidney failure. Antibiotics, specific antiviral medications and antifungal agents like amphotericin B can cause kidney problems and may need to be discontinued. It is important to alert the physician to all of the medications a person is taking because a combination of drugs or procedures may cause problems when used together. The physician will monitor kidney function closely when prescribing any of these treatments to minimize the risk of kidney failure.