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Drug-associated acute kidney injury: who’s at risk?

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Abstract

The contribution of nephrotoxic medications to the development of acute kidney injury (AKI) is becoming better understood concomitant with the increased incidence of AKI in children. Treatment of AKI is not yet available, so prevention continues to be the most effective approach. There is an opportunity to mitigate severity and prevent the occurrence of AKI if children at increased risk are identified early and nephrotoxins are used judiciously. Early detection of AKI is limited by the dependence of nephrologists on serum creatinine as an indicator. Promising new biomarkers may offer early detection of AKI prior to the rise in serum creatinine. Early detection of evolving AKI is improving and offers opportunities for better management of nephrotoxins. However, the identification of patients at increased risk will remain an important first step, with a focus on the use of biomarker testing and interpretation of the results.

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Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA

    Emily L. Joyce & Dana Y. Fuhrman

  2. Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh School of Medicine , Pittsburgh, PA, 15261, USA

    Sandra L. Kane-Gill

  3. Department of Pharmacy, UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA

    Sandra L. Kane-Gill

  4. Center for Critical Care Nephrology, UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA

    Sandra L. Kane-Gill, Dana Y. Fuhrman & John A. Kellum

  5. Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Laboratory, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA

    Dana Y. Fuhrman & John A. Kellum

  6. Department of Critical Care Medicine, UPMC, University of Pittsburgh School of Medicine, 615 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA

    Sandra L. Kane-Gill, Dana Y. Fuhrman & John A. Kellum

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  1. Emily L. Joyce
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Correspondence to John A. Kellum.

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JA Kellum receives grant and consulting fees from Astute Medical, Inc., Baxter, Inc., and Bard Inc.

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5T32DK091202-05, NIH/NIDDK

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1: d

2: b

3: e

4: c

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Joyce, E.L., Kane-Gill, S.L., Fuhrman, D.Y. et al. Drug-associated acute kidney injury: who’s at risk?. Pediatr Nephrol 32, 59–69 (2017). https://doi.org/10.1007/s00467-016-3446-x

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