engleski

Drug-induces Diseases of the Kidney and Fluids and Electrolyte Disorders

TEMPUS Module topics: Renal Adverse Drug Reactions ; Drug-induced Acute Renal Diseases ; Syndrome of Inappropriate Antidiuretic Hormone ; Secretion and Diabetes Insipidus ; Drug-induced Chronic Kidney Disease ; Drug-induced Acid-Base Disorders ; Pharmaceutical care The kidney represents a major target for adverse drug reactions (ADR) due to its role in drug excretion and in the control of body fluids and electrolyte homeostasis. It excretes many of drug metabolites and is exposed to high concentrations of these xenobiotics. Several renal transport processes potentially lead to accumulation of drugs in renal cells. Since renal function is so diverse, it is impossible to give a unique definition of a renal adverse reaction. Drug-induced decrease in renal function is a major side effect in clinical practice. ADRs are mainly divided into acute renal failure (ARF) and chronic renal failure (CRF). ARF is defined as an acute onset of severe deterioration of renal function necessitating renal replacement therapy, while CRF deterioration of renal function proceeds more progressively. Drug-induced nefrotoxicity is a major cause of hospital-acquired ARFs and antibiotics (aminoglycosides, amphotericin B and piperacillin), NSAIDs, cyclosporine and ACE inhibitors are high on the list. Nefrotoxicity is also the main adverse effect of calcineurin inhibitors (cyclosporine and tacrolimus) that are used as imunosuppressant agents after organ transplantation and in treatment of psoriasis, as well as of autoimmune diseases. ARF occurs in up to 5% of hospitalized patients and it has been estimated that approximately 20% of these cases are caused by drugs. In an analysis of adverse events in hospitalized patients, renal dysfunction accounted for 6.7% of drug-related complications. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) and diabetes insipidus (DI) are conditions of altered water balance relating to the abnormal secretion and/or action of antidiuretic hormone (ADH). SIADH causes inappropriate reabsorption of water in the nephron, resulting in hyponatremia, while DI causes hypernatriemia as a result of the loss of large amounts of dilute urine. Drugs that have been reported to cause SIADH and DI are from tricyclic antidepressants, antipsyhotic agents, cancer chemotherapy, antiepileptics, and oral hypoglycemic. Many drugs can negatively affect acid-base homeostasis. Prevention of drug-induced acid-base disorders involves an awareness of the drugs that can cause these conditions as well as knowledge of patients factors that can contribute to an increased risk. Pharmacist skilled in these areas can play significant role in the prevention, identification, and management of these potentially life treating disturbances, and his role includes anticipation of drug-related acid-base disturbances, avoidance or minimization of the clinical consequences, and the design of appropriate treatment regimens. A traditional pharmaceutical care approach 'correct medicine in the correct dose at the correct time' to individual patient is only the first stage in the therapeutic process, and should be completed 'by helping patient to use his medicine in a way that ensures optimum benefit'. Effective pharmacy practice, based on research evidence and best practice, requires an understanding of the social context within which pharmacy is practised, recognising the particular needs and circumstances of the users of pharmaceutical services, and of pharmacy's place within health service provision. 1. Pharmacovigilance, 2nd Ed., R. D. Mann and E. B. Andrews (Eds.), John Wiley & Sons, Ltd., Chichester, England 2007. 2. Drug-Induced Diseases – Prevention, Detection and Management, J. E. Tisdale & D. A. Miller (Eds), American Society of Health-System Pharmacists (ASHP), Bethesda, Maryland 2005. 3. Pharmacy Practice, K. Taylor & G. Harding (Eds), Taylor & Francis, London 2001. 4. Minor Illness or Mayor Disease?- Responding to symptoms in the pharmacy, 3rd Ed., C. Edwards / P. Stillman (Eds), Pharmaceutical Press, London 2000. 5. Burger's Medicinal Chemistry – Drug Discovery, Volume 2, Drug Discovery and Drug Development, 6th Ed, D. J. Abraham, John Willey & Sons, Inc., Publication, New Jersey 2003. 6. Janković, N. Mirošević, M. Jadrijević-Mladar Takač, S. Tomić & V. Macolić-Šarinić, The Significance and Severity of Drug-drug Interactions among Reported Adverse Drug Events, ADEs, in Croatia, Pre-Satelite Young Pharmaceutical Scientists Meet in Amsterdam, PSWC 2007 - Optimizing Therapy: An Imperative for World Health, Amsterdam, 19-20 April, 2007. Book of abstracts, p. 115, http://www.fip.org/PSWC/ ; http://pharmacie.univ-lille2.fr/presatelitePSWC/.

Kidny disease; Adverse drug reaction; ADRs; Drug-induced kidney disease

nije evidentirano