What are the nephrotoxic agents in the patient's medication list?

Nephrotoxic Agents in the Medication List

The only nephrotoxic agent in this medication list is aspirin (aspirin EC 81 mg PO QD), which can cause hemodynamic changes in the kidney by inhibiting prostaglandin synthesis. 1, 2

Analysis of Nephrotoxic Potential

Confirmed Nephrotoxic Agent:

• Aspirin EC 81 mg PO QD: Even at low doses, aspirin belongs to the NSAID class, which can cause nephrotoxicity through several mechanisms:
  • Inhibition of prostaglandin synthesis leading to reduced renal blood flow 2
  • Potential for acute interstitial nephritis 2
  • Renovasoconstriction, particularly in patients with pre-existing kidney disease 1

Medications Without Significant Nephrotoxicity:

1. Atorvastatin 10 mg PO QHS - Not nephrotoxic
2. MiraLax 17 g PO PRN - Not nephrotoxic
3. Depakote DR 125 mg PO BID - Not nephrotoxic
4. Santyl 250 unit/g topical QD - Topical; minimal systemic absorption
5. Cholecalciferol 75 mcg PO QD - Not nephrotoxic
6. Renal-Vite 0.8 mg PO QD - Not nephrotoxic
7. Mupirocin 2% topical QD - Topical; minimal systemic absorption
8. Folic Acid 1 mg PO QD - Not nephrotoxic
9. Metoprolol Tartrate 25 mg PO BID - Not nephrotoxic
10. Levothyroxine 25 mcg PO QAM - Not nephrotoxic
11. Docusate Sodium 100 mg PO BID - Not nephrotoxic
12. Ferrous Sulfate 325 mg PO QD - Not nephrotoxic
13. Acetaminophen 325 mg PO - Not directly nephrotoxic at therapeutic doses

Risk Assessment for Aspirin

While aspirin is nephrotoxic, the risk at the low dose of 81 mg daily is relatively low compared to higher doses or other NSAIDs. However, the nephrotoxic potential increases in certain situations:

• In patients with pre-existing kidney disease (GFR <60 ml/min/1.73 m²) 1
• During acute illness or volume depletion 2
• When combined with other medications that affect renal hemodynamics 2
• In elderly patients 3

Recommendations for Management

1. Monitor renal function regularly with serum creatinine and BUN measurements, especially if the patient has risk factors for kidney disease 1

2. Consider temporary discontinuation of aspirin during:

   • Acute illness with volume depletion
   • Planned IV contrast administration
   • Bowel preparation for colonoscopy
   • Prior to major surgery 1

3. Avoid adding other nephrotoxic medications to the regimen, as each additional nephrotoxin increases the risk of acute kidney injury by approximately 53% 2

4. Ensure adequate hydration, particularly important when the patient is also taking medications that may affect volume status 2

Conclusion

The medication list contains only one nephrotoxic agent - aspirin EC 81 mg PO QD. While the low dose presents minimal risk in patients with normal renal function, monitoring is still warranted, particularly in high-risk patients or during situations that may compromise renal function.