Core61: Drug-induced adverse reaction: nephrotoxicity

🧪 High-yield / 要点：Drug-induced nephrotoxicity can result from direct renal toxicity or reduced renal perfusion. Classic causes: platinum chemotherapy, aminoglycosides, vancomycin, contrast media, NSAIDs, ACE inhibitors, ARBs.

Symptoms / 症状

• Reduced urine output.
• Dark urine.
• Hypertension.
• Swollen face, ankles, or feet.
• Anemic symptoms:
  • Fatigue.
  • Weakness.

Causes / 原因

Mechanism	Examples	Key idea
Direct toxicity	Platinum-based chemotherapy, aminoglycosides, vancomycin, contrast dyes	Direct tubular/renal injury
Reduced perfusion	NSAIDs, ACE inhibitors, ARBs	Hemodynamic fall in GFR

High-yield mechanisms / 重要機序

• NSAIDs:
  • Inhibit afferent vasodilation.
  • Can reduce renal blood flow and GFR.
• ACE inhibitors / ARBs:
  • Inhibit systemic vasoconstriction.
  • Inhibit efferent arteriole vasoconstriction.
  • This lowers intraglomerular pressure and can reduce GFR.
• Aminoglycosides / vancomycin / contrast media:
  • Typical direct nephrotoxins.
• Platinum chemotherapy:
  • Important oncology cause of nephrotoxicity.

Management / 対応

• Stop the offending drug immediately.
• Supportive treatment according to severity:
  • BP control.
  • Fluid and electrolyte replacement.
  • Hemodialysis if needed.
• Monitor kidney function.

Remember / 覚え方

• Direct toxicity + low perfusion = nephrotoxicity
• NSAIDs affect afferent side
• ACEi/ARB affect efferent side
• Aminoglycosides and platinum drugs are classic nephrotoxins