Drug-Induced Alterations in Renal Hemodynamics

Renal dysfunction and injury secondary to medications are common. Drug-related kidney injury can present as subtle damage or rapid progressive renal failure and is thought to be one of the major causes of renal failure. Most of the nephrotoxic medications involve directly or indirectly renal tubulointerstitial injury via immune process and lead to specific clinical findings, including microangiopathy, Fanconi syndrome, acute tubular necrosis, acute interstitial nephritis, nephrotic syndrome, obstruction, nephrogenic diabetes insipidus, electrolyte abnormalities, and chronic renal failure. Some drugs perturb renal perfusion and induce loss of filtration capacity. In vivo and in vitro research on drugrelated kidney diseases had greatly enhanced our understanding on drug nephrotoxicity in the past decade. Understanding the mechanisms involved and recognizing the clinical presentations of renal dysfunction arising from the use of commonly prescribed medications are important if injury is to be detected and prevented earlier. Knowledge of drug effects on renal hemodynamics can also give us an insight into the nature of progression of renal failure from drug-induced renal injury, which constitutes a major cause of end-stage renal disease. Drug-induced alternations in renal hemodynamics have rarely been a subject of attention. This paper reviews the clinical features and basic processes of renal hemodynamic alteration related to the use of common drugs.