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. 2021 Mar;9(5):400.
doi: 10.21037/atm-20-3826.

The clinicopathological features of drug-induced acute kidney injury-a single-center retrospective analysis

Yu Cui  1   2   3 , Yi Yang  1   2   3 , Wenhua Lei  1   2   3 , Xiabing Lang  1   2   3 , Jianghua Chen  1   2   3
Affiliations

The clinicopathological features of drug-induced acute kidney injury-a single-center retrospective analysis

Yu Cui et al. Ann Transl Med. 2021 Mar.

Abstract

Background: This study aimed to analyze changes to the drug spectrum and clinicopathological features of drug-induced acute kidney injury (AKI) with recent medication habits changes.

Methods: A retrospective analysis of the characteristics of patients diagnosed with drug-induced AKI from January 2012 to October 2016 period at the First Affiliated Hospital of the Medical College of Zhejiang University was conducted.

Results: Between January 2012 and October 2016, 909 patients were diagnosed with AKI. Of these, 228 were diagnosed with drug-related AKI were engaged in this study, including 51 who underwent renal biopsies, 74 treated with antibacterial and antiviral drugs, and 63 who received nonsteroidal anti-inflammatory drugs (NSAIDs), and 17 who were treated with Chinese herbal medicine. AKI was most frequently associated with antibiotics and antiviral drugs, including cephalosporins, acyclovir, azithromycin, clindamycin, and levofloxacin. In those who underwent renal biopsy, 12 patients were diagnosed with allergic interstitial nephritis, 19 with interstitial nephritis, 8 with renal tubular epithelial cell injury, 2 with minimal change nephropathy, 2 with IgA nephropathy, and 2 with mild mesangial hyperplasia with glomerulosclerosis. The mean follow-up time was 437 days, ranging from 3 to 2,756 days. Among 228 patients, 165 recovered completely, 4 recovered partially, 8 did not recover, and 51 were lost to follow-up after discharge.

Conclusions: The three main contributors to drug-induced AKI were antimicrobial agents, NSAIDs, and Chinese herbal medicines. The age distribution of the three different drug-induced AKI groups was significantly different. Allergic interstitial nephritis, interstitial nephritis, and tubular epithelial cell injury were the main pathological manifestations of drug-induced AKI. The novel predictive nomogram achieved a good performance of prediction recovery within 2 weeks in drug-induced AKI patients.

Keywords: Drug-induced acute kidney injury; nephrotoxicity; nomogram; prognosis; renal pathology.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-3826). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
High-power photomicrograph showing (A) relatively normal glomeruli and severe acute tubular injury in the interstitial area (Hematoxylin & Eosin); (B) severe acute tubular injury and mononuclear cell infiltration with interstitial edema (Hematoxylin & Eosin).
Figure 2
Figure 2
Maximum serum creatinine of different drugs.
Figure 3
Figure 3
Pharmaceutical agents causing AKI. AKI, acute kidney injury.
Figure 4
Figure 4
The progress of drug-induced AKI. AKI, acute kidney injury.
Figure 5
Figure 5
Nomogram of predictors for predicting recovery within 2 weeks of drug-induced AKI. Drug 8 = Antimicrobial agents, Drug 11 = NSAIDs, Drug 13 = Chinese herbal medicine. AKI, acute kidney injury.
Figure 6
Figure 6
Calibration plots of internal validation.
See this image and copyright information in PMC

References

    1. Schetz M, Dasta J, Goldstein S, et al. Drug-induced acute kidney injury. Curr Opin Crit Care 2005;11:555-65. 10.1097/01.ccx.0000184300.68383.95 - DOI - PubMed
    1. Mehta RL, Pascual MT, Soroko S, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int 2004;66:1613-21. 10.1111/j.1523-1755.2004.00927.x - DOI - PubMed
    1. Ali T, Khan I, Simpson W, et al. Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol 2007;18:1292-8. 10.1681/ASN.2006070756 - DOI - PubMed
    1. Hoste EA, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med 2015;41:1411-23. 10.1007/s00134-015-3934-7 - DOI - PubMed
    1. Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int 2012;81:442-8. 10.1038/ki.2011.379 - DOI - PMC - PubMed

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