What drugs can cause renal impairment?

Medications that can damage the kidneys are known as “nephrotoxic medications.” These drugs can cause direct damage to the kidneys. Some of these medications mildly worsen kidney function and others can cause acute kidney injuries. The risk for kidney damage depends on your individual health and other medications you are taking. For people with even mild kidney failure, you might want to talk to your doctor about the pros and cons of these medications.

1) NSAIDS

NSAIDS, or nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin) and naproxen (Aleve), lead the list for drugs that cause kidney damage because of their widespread use. NSAIDS are used to treat a host of conditions such as fever, rheumatoid arthritis, menstrual pain, and inflammation, but they can also reduce the amount of blood flow to the kidneys, resulting in a potential for kidney damage or failure. People with heart failure, liver disease, or previous kidney problems are at even higher risk when taking NSAIDS.

In general, try to use these medications sparingly, at their lowest effective dose for the shortest period of time.

2) Vancomycin

Patients with severe methicillin-resistant Staphylococcus aureus (MRSA) infections are often treated with the IV antibiotic, vancomycin. Because this medication can cause kidney damage and acute interstitial nephritis (swelling in the kidneys) in some patients, your doctor will closely monitor your kidneys for any injury while treating your infection.

3) Diuretics

Diuretics, or water pills, are used to treat conditions like high blood pressure, glaucoma, and edema, but as with all medications, they come with some risks. Popular diuretics include hydrochlorothiazide, furosemide, and spironolactone. They are associated with a risk for acute kidney injury.

4) Iodinated radiocontrast

Although this sounds like a complicated term, “iodinated radiocontrast” refers to any contrast dyes used in diagnostic testing, such as a CT scan. Iodinated radiocontrast agents are one of the most common causes of kidney injury among hospitalized patients, occurring within 24 to 48 hours after receiving an IV contrast injection.

5) ACE inhibitors

ACE inhibitors can be good and bad for your kidneys. These are medications that tend to end in “-il,” like lisinopril, enalapril, and ramipril. ACE inhibitors are popular drugs for high blood pressure and heart failure.

Because ACE inhibitors are metabolized by the kidneys, they do come with a risk of causing kidney damage, especially if you are dehydrated, which is often the case in people with existing kidney problems—like chronic kidney disease. If you are at a higher risk for kidney damage but need an ACE inhibitor, you will likely start on a low dose, and your doctor may need you to come in for routine blood creatinine tests to monitor the health of your kidneys.

6) Jardiance

Jardiance is a diabetes medication that may protect the kidneys in patients with diabetes but has also been reported in rare cases to cause kidney failure. Importantly, Jardiance has diuretic effects and interacts with other nephrotoxic drugs (drugs on this list), raising the risk for toxic kidney effects. Again, rare, but it can happen.

7) Aminoglycoside antibiotics

Aminoglycoside antibiotics are known for causing kidney injury—even at low doses. People with chronic kidney disease, dehydration, or those who have been taking these antibiotics for a long time are at particularly high risk. The most toxic aminoglycoside is neomycin, followed by gentamicin, tobramycin, and amikacin. Streptomycin is the least toxic. Although these medications are typically used in hospitals, they are important to keep at the back of your mind!

8) HIV medications and antiviral drugs

Certain antiviral HIV medications are linked to long-term kidney damage and can increase your risk for kidney disease. Viread (tenofovir) and Reyataz (atazanavir) have both been shown to cause acute kidney injury.

9) Zoledronic acid

Zoledronic acid (Zometa, Reclast) is typically used to treat osteoporosis but is a known cause of kidney damage and renal failure. Zometa is an important IV medication for treating metastatic bone cancer, but does come with a well-known potential to impair kidney function.

10) Foscarnet

Foscarnet, also given by IV, is a rarely used drug that treats viral infections in patients with weakened immune systems. It can be highly toxic to the kidneys, so if you need it, your doctor will closely monitor your kidney function.

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There you have it!

Dr O.

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