I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on November 19, 2007, 12:12:59 AM
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HEALTH & SCIENCE
Nephrologists warn of kidney failure induced by drugs, medical procedures
As the population with renal damage grows, experts are looking to reduce the risk of this occurring as the result of medical care.
By Victoria Stagg Elliott, AMNews staff. Nov. 26, 2007.
The number of people with kidney disease is increasing, but experts say that not all cases can be blamed on increasing rates of obesity, diabetes and hypertension that are so often cited as likely causes.
The things physicians do as part of patient care also might inadvertently cause damage, and physicians need to be aware of this possibility, according to a session at the Renal Week 2007, the American Society of Nephrology's 40th Annual Meeting and Scientific Exposition in San Francisco last month.
"When you talk about drugs having toxicity, it's very common for that negative effect to be in the kidney," said Glen Markowitz, MD, associate professor of clinical pathology at Columbia University in New York. "We need to educate physicians on recognizing these toxicities."
And some of the newly discovered causes of iatrogenic kidney disease are fairly common parts of medical practice.
For example, Dr. Markowitz presented information on the kidney failure that can result from ingesting oral sodium phosphate solution to prepare the bowels for colonoscopy or surgery. Several studies, including some he wrote, have documented several dozen cases, particularly among older women taking hypertension medications or nonsteroidal anti-inflammatories. The Food and Drug Administration warned of this adverse event last year and called for these preparations not to be used in those at high risk for kidney failure. Ample hydration can help make this complication less likely.
Additional areas of concern
Nephrologists also are concerned about bisphosphonates used to treat osteoporosis, Paget's disease and bone metastases associated with some cancers. These drugs may damage the kidneys, although data suggest that this scenario is most likely when the drugs are used at high doses in patients who already have some kidney problems.
"To get toxicities, you really have to [take] more than the approved amount or [take the drug] more frequently than is approved. Having some decreased renal function also makes it more likely," said Daniel W. Coyne, MD, professor of medicine in the renal division at Washington University School of Medicine in St. Louis. "In patients with decreased kidney function, you should consider whether you're administering the right dose or whether you want to use these drugs."
13% of Americans had some form of chronic kidney disease in the period from 1999 to 2004.
Experts urge assessment of a patient's kidney before starting these drugs, particularly if the medicine will be taken in large quantities. Also, doctors should consider discontinuing them if problems develop.
By far the most controversial possibility emerging from the data is that newer contrast agents for various scanning modalities such as computed tomography and magnetic resonance imaging might be toxic to the kidneys. Older iodine-based contrast agents have long been recognized as possible culprits in this adverse event, but newer gadolinium-based ones may also have this affect, particularly for patients who already have some kidney problems.
"Some [studies] show no potential for risk, while others clearly show that there is a risk for this complication. It is my conclusion that gadolinium may cause further kidney damage in cases where the recipient has prior kidney disease," said Roger Rodby, MD, a nephrologist and associate professor of medicine at Rush University Medical Center in Chicago.
Experts are recommending caution when using gadolinium in this population. Not only can it cause further damage to the kidneys, in some cases it can trigger a very painful skin condition.
It's unknown how much kidney disease is caused by medical care itself. Meanwhile, the rates of this disorder are increasing and expected to continue to do so.
This phenomenon is primarily explained by the increasing rates of obesity, diabetes, hypertension and the aging of the population.
According to the latest numbers from the United States Renal Data System, the prevalence of end-stage renal disease will grow by 60% between 2005 and 2020.
These projections were presented at last month's meeting. Also, a study in the Nov. 7 Journal of the American Medical Association found that from 1999 to 2004 more than 13% of the population had some form of chronic kidney disease. These figures marked an increase from the 10% documented from 1988-1994. That study did not count those who were at the end stages.
ADDITIONAL INFORMATION:
ESRD rates rising
Researchers have projected that the number of people with end-stage renal disease will grow dramatically over the next decade because of the aging of the population and increasing diabetes rates. Improvements in medical care also mean that patients with damaged kidneys are living longer. While ESRD rates are still expected to climb, the latest predictions are not as high as those made previously. The reasons why are unclear.
Here is how ESRD prevalence projections compare:
ESRD patients With 2000 data With 2005 data
In 2005 489,200 484,995
In 2010 593,953 579,105
In 2015 713,531 679,918
In 2020 No projection 784,613
Source: Renal Week 2007, the American Society of Nephrology's 40th Annual Meeting and Scientific Exposition
Weblink
American Society of Nephrology's Renal Week, Oct. 31-Nov. 5 (www.asn-online.org/education_and_meetings/Renal Week/renal_week.aspx)
United States Renal Data System (www.usrds.org)
http://www.ama-assn.org/amednews/2007/11/26/hlsb1126.htm
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Additional areas of concern
Nephrologists also are concerned about bisphosphonates used to treat osteoporosis, Paget's disease and bone metastases associated with some cancers. These drugs may damage the kidneys, although data suggest that this scenario is most likely when the drugs are used at high doses in patients who already have some kidney problems.
My mom donated a kidney to me 25 years ago, and now is on meds for osteoporosis, where does that leave her in terms of risk? I'm sure the docs didn't test for that possibility when looking at risk after donating. She also uses NSADs (Aleve) quite a bit, maybe I could at least convince her to use Tylenol instead.
Thanks again, Karol!! You're great at keeping us informed!
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Some analgesics may cause kidney damage, when taken every day for years. The new labels usually suggest a week or two at most.
analgesic nephropathy
http://uimc.discoveryhospital.com/main.php?t=enc&id=527
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I'm not so sure my kidney failure is related to my diabetes anymore. I just recently got a hold of my medical records from 2005 and found something suspicious. My creat was normal until I went into Johns Hopkins. I had to call an ambulance for severe coughing and vomiting up blood (this was the second time in 2 months). I didn't have insurance and they booted me out 2 days later (their diagnosis was asthma!), swollen up like a balloon, with a raging infection creeping up my arm through the veins, where the IV was! The next day I went to see my family doctor and she did blood work. My creat had jumped to 2.4. It never went back down! I'm so pissed at Johns Hopkins and highly suspect they caused my kidney failure!
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I would be upset too. I am upset that I wasn't told how much damage a botched aspiration had done until my kidneys started to improve somewhat about a month before my transplant. Of course they would never function at a normal level, but I feel the quality of my life suffered for a year. My family doctor and nephrologist said the same thing, "We aren't saying anyone did anything wrong, but we don't want you ever admitted to that hospital again." Duh? I think someone did something wrong.
Hey Paddbear, let's go kick some..................... :boxing; :boxing; :boxing;
All the stuff that happened to me was in 2005 too!
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:boxing; :boxing; :boxing;
I'm with ya! Johns Hopkins is EVIL!!!