Insuffisances rénales aiguës médicamenteuses

Abstract

Drug-induced acute renal failure (ARF) is common. Many therapeutic agents may induce ARF and there are numerous mechanisms that cause drug-induced ARF. The mechanisms may act at the vascular, glomerular or tubular levels. Drug toxicity may be related to the effects of the treatment itself or caused by hypovolaemia or disturbances of intrarenal haemodynamics. During the course of ARF, diagnosis should systematically include consideration of drug-related precipitating or predisposing factors. Drug-induced ARF is an undesirable iatrogenic occurrence that is largely avoidable and which has a more favourable prognosis than ARF of different pathogenesis. Treatment of this type of ARF is based on prevention. Any drug that is potentially toxic to the kidney should be prescribed in strict accordance with the indications and contraindications of the therapy. Prescription must take into account drug interactions and constitutional susceptibility (pre-exciting chronic renal failure, cirrhosis, old age). Dosage must be adapted to the glomerular filtration rate as estimated by the formula of Cockcroft-Gault. Hypovolaemia must be prevented or corrected.