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Nephrotoxic Drug

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1. Evaluation of Adverse Drug Reaction Profile of Drugs Used as First-Line Antiretroviral Therapy Full Text available with Trip Pro

Evaluation of Adverse Drug Reaction Profile of Drugs Used as First-Line Antiretroviral Therapy The objective was to study the adverse drug reaction (ADR) profile in HIV patients receiving first-line antiretroviral therapy.This was a prospective, observational study that included 171 HIV patients with a follow-up at six months. Demographic details, medical history, details of HIV infection including most recent CD4 count, details of antiretroviral therapy, and other concomitant medication were (...) recorded. Adverse drug reactions were elicited by reviewing patient records and also by interviewing the patient/attendants directly.171 patients completed the study out of which 88 (51.5%) were males and 83 (48.5%) were females. The study subjects included HIV-positive, treatment naïve patients who were started on treatment regimens recommended by the NACO guidelines. The ADRs observed were a fall in haemoglobin or absolute anaemia in response to zidovudine, nonspecific symptoms like headache

2018 Interdisciplinary perspectives on infectious diseases

2. Drug therapy and other factors associated with the development of acute kidney injury in critically ill patients: a cross-sectional study Full Text available with Trip Pro

Drug therapy and other factors associated with the development of acute kidney injury in critically ill patients: a cross-sectional study Acute kidney injury (AKI) is associated with a significant increase in morbidity, mortality, and health care costs. In intensive care units (ICU), AKI is commonly multifactorial and frequently involves diverse factors, such as hypovolemia, sepsis, and the use of nephrotoxic drugs. We aimed to investigate drug therapy and other factors associated (...) . This association was independent of drug nephrotoxicity.Intensive care is characterized by its complexity that combines unstable patients, severe diseases, high density of medical interventions, and drug use. We found that typical risk factors for AKI showed statistical association on bivariate analysis. The contribution of drug therapy in the occurrence of AKI in medical ICUs reinforces the need for prevention strategies focused on early recognition of renal dysfunction and interventions in drug therapy

2018 PeerJ

3. Incident hepatocellular carcinoma developing during tenofovir alafenamide treatment as a rescue therapy for multi-drug resistant hepatitis B virus infection: A case report and review of the literature Full Text available with Trip Pro

Incident hepatocellular carcinoma developing during tenofovir alafenamide treatment as a rescue therapy for multi-drug resistant hepatitis B virus infection: A case report and review of the literature Tenofovir disoproxil fumarate (TDF) is a potent nucleotide analogue with high barrier to resistance, which is recommended for multi-drug resistant hepatitis B virus (HBV) infection. However, nephrotoxicity has been reported during TDF treatment, and tenofovir alafenamide (TAF), which has (...) comparable efficacy to TDF and improves bone and renal safety, can be used as a replacement strategy. Herein, we describe a clinical case concerning a 60-year-old individual suffering liver cirrhosis and renal dysfunction, and being infected with multidrug-resistant HBV. When failing treatment with TDF, he received TAF as a rescue therapy. TAF effectively inhibited HBV replication without worsening renal function or serum phosphorus abnormality. Furthermore, hepatocellular carcinoma (HCC) occurred during

2018 World journal of clinical cases

4. Acute kidney injury during colistin therapy: a prospective study in patients with extensively-drug resistant Acinetobacter baumannii infections. (Abstract)

Acute kidney injury during colistin therapy: a prospective study in patients with extensively-drug resistant Acinetobacter baumannii infections. The study aimed to prospectively assess incidence and risk factors for colistin-associated nephrotoxicity. This is a secondary analysis of a multicentre, randomized clinical trial, comparing efficacy and safety of colistin versus the combination of colistin plus rifampicin in severe infections due to extensively drug-resistant (XDR) Acinetobacter (...) baumannii. The primary end point was acute kidney injury (AKI) during colistin treatment, assessed using the AKI Network Criteria, and considering death as a competing risk. A total of 166 adult patients without baseline kidney disease on renal replacement therapy were studied. All had life-threatening infections due to colistin-susceptible XDR A. baumannii. Patients received colistin intravenously at the same initial dose (2 million international units (MIU) every 8 h) with predefined dose adjustments

2017 Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases Controlled trial quality: uncertain

5. Polymyxin B Monotherapy vs Combination Therapy in Critically Ill Patients With Multi-drug Resistant Pathogens

Therapy in Critically Ill Patients With Multi-drug Resistant Gram-negative Infection: A Prospective, Parallel-Group, Double-Blind, Randomized Controlled Study Actual Study Start Date : May 25, 2017 Estimated Primary Completion Date : December 1, 2019 Estimated Study Completion Date : December 1, 2019 Resource links provided by the National Library of Medicine available for: resources: Arms and Interventions Go to Arm Intervention/treatment Polymyxin B monotherapy Intravenous piggyback with Polymyxin B (...) Polymyxin B Monotherapy vs Combination Therapy in Critically Ill Patients With Multi-drug Resistant Pathogens Polymyxin B Monotherapy vs Combination Therapy in Critically Ill Patients With Multi-drug Resistant Pathogens - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies

2017 Clinical Trials

6. Utility of Electronic Medical Record Alerts to Prevent Drug Nephrotoxicity. Full Text available with Trip Pro

Utility of Electronic Medical Record Alerts to Prevent Drug Nephrotoxicity. Nephrotoxin-induced AKI is an iatrogenic form of AKI that can be potentially avoided or ameliorated by prompt recognition and appropriate prescriber actions. Drug-targeted alerts, either for patients at risk of AKI or patients with existing AKI, may lead to more appropriate drug dosing and management and improved clinical outcomes. However, alerts of this type are complicated to create, have a high potential for error (...) and off-target effects, and may be difficult to evaluate. Although many studies have shown that these alerts can reduce the rate of inappropriate prescribing, few studies have examined the utility of such alerts in terms of patient benefit. In this review, we examine the current state of the literature in this area, identify key technical challenges, and suggest methods of evaluation for drug-targeted AKI alerts.Copyright © 2019 by the American Society of Nephrology.

2018 Clinical Journal of the American Society of Nephrology

7. Prescribing medicines in renal impairment: using the appropriate estimate of renal function to avoid the risk of adverse drug reactions

dosage adjustments creatinine clearance (CrCl) should be calculated using the Cockcroft-Gault formula (see below) to determine dosage adjustments for: direct-acting oral anticoagulants (DOACs) patients taking nephrotoxic drugs (examples include vancomycin and amphotericin B) elderly patients (aged 75 years and older) patients at extremes of muscle mass (BMI <18 kg/m2 or >40 kg/m2) patients taking medicines that are largely renally excreted and have a narrow therapeutic index, such as digoxin (...) when initiating or adjusting dose in people taking nephrotoxic drugs, elderly patients, and patients at extremes of muscle mass. CrCl should also be considered for dosage adjustment of medicines that are substantially renally excreted and have a narrow therapeutic index. In particular, CrCl should always be used to guide dose adjustment for direct-acting oral anticoagulants (DOACs; apixaban, dabigatran etexilate, edoxaban▼, and rivaroxaban▼). Use of eGFR for dosing of DOACs is known to increase

2019 MHRA Drug Safety Update

8. Comparable Efficacy of Tigecycline versus Colistin Therapy for Multidrug-Resistant and Extensively Drug-Resistant Acinetobacter baumannii Pneumonia in Critically Ill Patients Full Text available with Trip Pro

Comparable Efficacy of Tigecycline versus Colistin Therapy for Multidrug-Resistant and Extensively Drug-Resistant Acinetobacter baumannii Pneumonia in Critically Ill Patients Tigecycline has in vitro activity against multidrug-resistant and extensively drug-resistant Acinetobacter baumannii (MDR/XDRAB), and may constitute an alternative therapy for treating pneumonia caused by MDR/XDRAB. The aim of this study was to compare the efficacy of tigecycline-based therapy with colistin-based therapy (...) % in the tigecycline group and 48% in the colistin group (P = 0.95). There were no differences between the groups with regard to other clinical outcomes, with the exception that nephrotoxicity was observed only in the colistin group (0% vs. 20%; P = 0.009). Clinical and microbiological success rates were numerically higher, and mortality rates were numerically lower in combination therapy group than in the monotherapy group. Multivariate analysis indicated that monotherapy was independently associated

2016 PloS one

9. Nephrotoxic medications and acute kidney injury risk factors in the neonatal intensive care unit: clinical challenges for neonatologists and nephrologists. (Abstract)

Nephrotoxic medications and acute kidney injury risk factors in the neonatal intensive care unit: clinical challenges for neonatologists and nephrologists. Neonatal acute kidney injury (AKI) is common. Critically ill neonates are at risk for AKI for many reasons including the severity of their underlying illnesses, prematurity, and nephrotoxic medications. In this educational review, we highlight four clinical scenarios in which both the illness itself and the medications indicated (...) for their treatment are risk factors for AKI: sepsis, perinatal asphyxia, patent ductus arteriosus, and necrotizing enterocolitis. We review the available evidence regarding medications commonly used in the neonatal period with known nephrotoxic potential, including gentamicin, acyclovir, indomethacin, vancomycin, piperacillin-tazobactam, and amphotericin. We aim to illustrate the complexity of decision-making involved for both neonatologists and pediatric nephrologists when managing infants with these conditions

2019 Pediatric Nephrology

10. Urinary biomarkers for early detection of platinum based drugs induced nephrotoxicity. Full Text available with Trip Pro

Urinary biomarkers for early detection of platinum based drugs induced nephrotoxicity. Nephrotoxicity is a major hazard complicating the use of platinum based drugs (PBD), which can hinder using higher doses protocols to maximize the therapeutic gain. Shortage of serum creatinine level as an accurate biomarker for acute kidney injuries (AKI) necessitates searching for novel biomarkers with better sensitivity and specificity in patients on PBD.In a prospective cohort design, 132 patients

2018 BMC Nephrology

11. Nephrotoxicity of Select Rheumatologic Drugs. (Abstract)

Nephrotoxicity of Select Rheumatologic Drugs. Several drugs commonly used in the management of rheumatic diseases may lead to nephrotoxicity, electrolyte disturbances, and hypertension. Here the authors focus on nonsteroidal antiinflammatory drugs, uric-acid-lowering therapy, and commonly used immunosuppressant therapies. The authors include a drug dosing table for patients with kidney disease.Copyright © 2018 Elsevier Inc. All rights reserved.

2018 Rheumatic Diseases Clinics of North America

12. Immunosuppressant drug tacrolimus induced mitochondrial nephrotoxicity, modified PCNA and Bcl-2 expression attenuated by Ocimum basilicum L. in CD1 mice Full Text available with Trip Pro

Immunosuppressant drug tacrolimus induced mitochondrial nephrotoxicity, modified PCNA and Bcl-2 expression attenuated by Ocimum basilicum L. in CD1 mice Tacrolimus (TAC) is used sporadically as an immunosuppressive agent for organ transplantation, but its clinical used is limited due to its marked nephrotoxicity. Ocimum basilicum L. (Lamiaceae) (OB) had been shown to possess antioxidant, anti-inflammatory and nephroprotective activity, and effective at improving renal inflammation (...) and glomerular. In our study, we aim to evaluate the efficacy of the OB against TAC-induced mitochondrial nephrotoxicity in CD1 mice. Mice were randomly divided into four groups. Group 1 (control group); administered orally with normal saline (1 mL/kg) for two weeks; Group 2 (OB extract treated-group) (500 mg/kg b.wt) gavaged once/day for two weeks; Group 3 (TAC-treated group) (3 mg/kg b.wt, administered ip once a day for two weeks); and Group 4; (TAC plus OB extract treated-group). Tacrolimus-induced

2018 Toxicology reports

13. Pharmacology behind Common Drug Nephrotoxicities. Full Text available with Trip Pro

Pharmacology behind Common Drug Nephrotoxicities. Patients are exposed to numerous prescribed and over-the-counter medications. Unfortunately, drugs remain a relatively common cause of acute and chronic kidney injury. A combination of factors including the innate nephrotoxicity of drugs, underlying patient characteristics that increase their risk for kidney injury, and the metabolism and pathway of excretion by the kidneys of the various agents administered enhance risk for drug-induced (...) nephrotoxicity. This paper will review these clinically relevant aspects of drug-induced nephrotoxicity for the clinical nephrologist.Copyright © 2018 by the American Society of Nephrology.

2018 Clinical Journal of the American Society of Nephrology

14. Advances in predictive in vitro models of drug-induced nephrotoxicity. Full Text available with Trip Pro

Advances in predictive in vitro models of drug-induced nephrotoxicity. In vitro screens for nephrotoxicity are currently poorly predictive of toxicity in humans. Although the functional proteins that are expressed by nephron tubules and mediate drug susceptibility are well known, current in vitro cellular models poorly replicate both the morphology and the function of kidney tubules and therefore fail to demonstrate injury responses to drugs that would be nephrotoxic in vivo. Advances (...) in protocols to enable the directed differentiation of pluripotent stem cells into multiple renal cell types and the development of microfluidic and 3D culture systems have opened a range of potential new platforms for evaluating drug nephrotoxicity. Many of the new in vitro culture systems have been characterized by the expression and function of transporters, enzymes, and other functional proteins that are expressed by the kidney and have been implicated in drug-induced renal injury. In vitro platforms

2018 Nature reviews. Nephrology

15. Development of Potential Orphan Drug Therapy of Intravesical Liposomes Tacrolimus for Hemorrhagic Cystitis by Increased Local Drug Exposure. (Abstract)

Development of Potential Orphan Drug Therapy of Intravesical Liposomes Tacrolimus for Hemorrhagic Cystitis by Increased Local Drug Exposure. The potent immunosuppressive effect of systemic tacrolimus is limited by the high incidence of severe adverse effects, including nephrotoxicity and hypertension. Intravesical application of tacrolimus is hindered by its poor aqueous solubility, justifying the search for novel delivery platforms such as liposomes. We evaluated the pharmacokinetics (...) of tacrolimus encapsulated in liposomes (lipo-tacrolimus), which is being developed as a potential orphan drug indication for hemorrhagic cystitis.A single dose of lipo-tacrolimus was instilled in the bladder with the rat under anesthesia. Also, tacrolimus was instilled intravesically or injected intraperitoneally in other rat groups. The tacrolimus dose was constant in all formulations at 200 μg/ml. At different times blood, urine and bladder samples were collected and stored at -80C until analysis

2012 Journal of Urology

16. Assessment of Urinary NGAL to Predict AKI in Children Receiving Multiple Nephrotoxic Medications

Assessment of Urinary NGAL to Predict AKI in Children Receiving Multiple Nephrotoxic Medications Assessment of Urinary NGAL to Predict AKI in Children Receiving Multiple Nephrotoxic Medications - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one (...) or more studies before adding more. Assessment of Urinary NGAL to Predict AKI in Children Receiving Multiple Nephrotoxic Medications (NINJA NGAL) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03527160 Recruitment Status : Enrolling by invitation First Posted : May 17, 2018 Last Update Posted

2018 Clinical Trials

17. Innovative use of novel biomarkers to improve the safety of renally-eliminated and nephrotoxic medications. (Abstract)

Innovative use of novel biomarkers to improve the safety of renally-eliminated and nephrotoxic medications. Over the last decade, the discovery of novel renal biomarkers and research on their use to improve medication effectiveness and safety has expanded considerably. Pharmacists are uniquely positioned to leverage this new technology for renal assessment to improve medication dosing and monitoring. Serum cystatin C is a relatively new, inexpensive, functional renal biomarker that responds (...) when renal cells undergo stress or sense a future risk of damage. Concentrations of [TIMP-2]·[IGFBP7] increase before a rise in serum creatinine is evident, thus providing insightful information for evaluation in the context of other patient data to predict the risk for impending kidney injury. This article provides a brief overview of novel renal biomarkers being used as a mechanism to improve medication safety including a discussion of cystatin C, as part of drug-dosing algorithms

2018 Pharmacotherapy

18. Nephrotoxicity of iodixanol versus iopamidol in patients undergoing peripheral angiography with or without endovascular therapy. (Abstract)

Nephrotoxicity of iodixanol versus iopamidol in patients undergoing peripheral angiography with or without endovascular therapy. To compare the nephrotoxic effects of iodixanol and iopamidol in patients undergoing peripheral angiography.Patients scheduled for peripheral angiography were randomly assigned to the iodixanol group (n = 463) and iopamidol group (n = 458). The primary endpoint was the incidence of contrast associated acute kidney injury (CA-AKI), which was defined as an increase ≥ 25 (...) the iodixanol group and iopamidol group (18.1% vs. 16.8%; p = 0.595). There was no significant difference in the mean peak SCr increase between the iodixanol group and iopamidol group (10.4 ± 13.0 vs. 10.6 ± 14.3 µmol/l, p = 0.919). There were four patients [1 (0.2%) patient in the iodixanol group and 1 (0.7%) patients in the iopamidol group, p = 0.609] with doubling of SCr; no other adverse renal events were observed.Our data showed that the nephrotoxicity of iodixanol was comparable with that of iopamidol

2019 International urology and nephrology Controlled trial quality: uncertain

19. Intrapartum care for women with existing medical conditions or obstetric complications and their babies

medical conditions or obstetric complications and their babies (NG121) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Last updated April 2019 Page 24 of 961.6.11 Be aware that non-steroidal anti-inflammatory drugs can add to the risk of bleeding. 1.6.12 Before discharge from hospital, inform women with bleeding disorders of the risk of secondary bleeding postpartum and how to access care. T o find out why the committee (...) considering giving a second continue to monitor fluid balance and renal function until the acute kidney injury has recovered. 1.8.8 Do not offer nephrotoxic drugs (for example, non-steroidal anti-inflammatory drugs) in the intrapartum period to women with kidney disease. 1.8.9 For all women with kidney disease during pregnancy: monitor the following at least every 4 hours for at least 24 hours after the birth: heart rate and blood pressure respiratory rate and chest auscultation fluid output and fluid

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

20. Association of nephrotoxicity during platinum-etoposide doublet therapy with UGT1A1 polymorphisms in small cell lung cancer patients. (Abstract)

Association of nephrotoxicity during platinum-etoposide doublet therapy with UGT1A1 polymorphisms in small cell lung cancer patients. Etoposide is a key agent in the treatment of small cell lung cancer (SCLC). Uridine diphosphate (UDP)-glucuronosyltransferase 1A1 (UGT1A1) is thought to be largely responsible for the glucuronidation of etoposide as well as that of irinotecan, suggesting that polymorphisms of UGT1A1 might be predictive of etoposide toxicity. We therefore examined the relation (...) /*28, or *6/*28 being observed in 9 (22.0%), 2 (4.9%), 2 (4.9%), 1 (2.4%), and 1 (2.4%) patients, respectively. The presence of these alleles was significantly associated with an increase in serum creatinine concentration of grade ≥2 (incidence of 66.7% for patients with the alleles versus 11.5% for those without, P <  0.001). Multivariate analysis also showed that these UGT1A1 alleles were significantly associated with therapy-induced nephrotoxicity (odds ratio of 19.30, 95% confidence interval

2018 Lung Cancer

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