What actions can lead to certain renal (kidney) failure?

From the Guidelines

Chronic and excessive use of certain medications, particularly non-steroidal anti-inflammatory drugs (NSAIDs), nephrotoxic medications, and untreated or poorly controlled medical conditions can lead to certain renal failure. Several behaviors can significantly increase the risk of kidney failure, including:

• Chronic and excessive use of NSAIDs like ibuprofen and naproxen, which can damage kidney tissue when taken in high doses over extended periods 1
• Nephrotoxic medications such as certain antibiotics (gentamicin, vancomycin), contrast dyes used in imaging studies, and some chemotherapy drugs can directly harm kidney cells
• Untreated or poorly controlled medical conditions including diabetes, hypertension, and heart failure place tremendous strain on kidney function over time
• Severe dehydration, especially when repeated or prolonged, forces kidneys to work harder with inadequate fluid support
• Heavy alcohol consumption damages kidney structures and impairs their ability to filter blood properly
• Recreational drug use, particularly heroin, cocaine, and MDMA, can cause acute kidney injury that may progress to chronic failure
• Consuming large amounts of certain dietary supplements or herbal remedies without medical supervision may introduce toxic compounds that kidneys must process These behaviors damage kidneys by various mechanisms including direct cellular toxicity, reduced blood flow to kidney tissues, inflammation, and increased filtration demands that eventually overwhelm these vital organs' capacity to function properly 1. It is essential to note that the risk of kidney failure can be increased by the use of certain medications, such as lithium, which can cause renal tubular dysfunction with prolonged use even at therapeutic levels 1.

The most recent and highest quality study 1 provides guidance on the evaluation and management of chronic kidney disease (CKD) and highlights the importance of identifying the specific cause of acute kidney injury (AKI) to provide appropriate intervention. The study also emphasizes the need for regular monitoring of kidney function, particularly in patients with preexisting kidney disease or those taking nephrotoxic medications.

In terms of prevention, it is crucial to avoid using concomitant NSAIDs and maintain hydration during intercurrent illness, especially in patients taking lithium or other nephrotoxic medications 1. Additionally, the use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin-receptor blockers (ARB) can help to slow the progression of CKD, but their use should be carefully monitored in patients with kidney disease 1.

Overall, the key to preventing kidney failure is to be aware of the potential risks and take steps to mitigate them, including avoiding excessive use of NSAIDs and other nephrotoxic medications, managing underlying medical conditions, and maintaining good kidney health through regular monitoring and lifestyle modifications.

From the FDA Drug Label

In these patients, administration of a NSAID may cause a dose-dependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation. Patients at greatest risk of this reaction are those with impaired renal function, heart failure, liver dysfunction, those taking diuretics and ACE inhibitors, and the elderly In addition, in patients who are elderly, volume-depleted (including those on diuretic therapy), or have compromised renal function, co-administration of NSAIDs with ACE inhibitors or ARBs may result in deterioration of renal function, including possible acute renal failure

The actions that can lead to certain renal (kidney) failure include:

• Administration of NSAIDs in patients with impaired renal function, heart failure, liver dysfunction, or those taking diuretics and ACE inhibitors
• Co-administration of NSAIDs with ACE inhibitors or ARBs in elderly, volume-depleted, or patients with compromised renal function
• Use of NSAIDs in patients with advanced renal disease 2
• Taking diuretics and NSAIDs, which can reduce the natriuretic effect of furosemide and thiazides and cause deterioration of renal function 3

From the Research

Actions Leading to Renal Failure

The following actions can lead to certain renal (kidney) failure:

• Long-term usage of nonsteroidal anti-inflammatory drugs (NSAIDs) in high cumulative dosages, which can cause acute kidney injury (AKI), tubulointerstitial nephritis (TIN), nephrotic syndrome, and chronic kidney disease (CKD) 4, 5
• Combination of NSAIDs with other agents, increasing the risk of kidney disease 5
• Inhibition of the biosynthesis of prostanoids involved in the maintenance of renal blood flow, especially PGE2 and PGI2, due to NSAID usage 4
• Traumatic or septic shock, leading to "shock kidneys" and potentially causing acute renal failure (ARF) 6
• Nephrotoxicity or ischemia, causing acute tubular necrosis and leading to AKI 7
• Certain medical conditions, such as hepatorenal syndrome, cardiorenal syndrome, rhabdomyolysis, and tumor lysis syndrome, which can increase the risk of AKI 8

Specific Factors Contributing to Renal Failure

Specific factors that can contribute to renal failure include:

• Pharmacological polytherapy, which can increase the risk of AKI associated with NSAID usage 4
• Presence of cardiovascular or hepatic comorbidities, which can increase the risk of AKI associated with NSAID usage 4
• Endotoxemia, which can release noxious cytokines like tumor necrosis factor-alpha (TNFa) and contribute to multi-organ failure (MOF) 6
• Bacterial translocation through the gastrointestinal mucosa, which can occur during shock and contribute to MOF 6