TITLE:
Drug-Induced Acute Kidney Injury in Diabetes Mellitus
AUTHORS:
Amel Harzallah, Hayet Kaaroud, Mariem Hajji, Fethi Ben Hamida, K. Khiari, I. Gorsane, Taieb Ben Abdallah
KEYWORDS:
Renal Failure, Nephrotoxicity, Drugs
JOURNAL NAME:
Open Journal of Nephrology,
Vol.6 No.4,
December
28,
2016
ABSTRACT: Background: Drug-induced acute kidney injury is a common situation in clinical practice. Many treatments
are involved and they are even more aggressive when associated with a
predisposing factor such as diabetes. We aimed to investigate clinical features of acute drug-induced kidney injury in
diabetics in order to clarify renal prognosis. Methods: This was a descriptive and analytical retrospective
study including diabetics who presented drug-induced acute kidney
injury, conducted in our department during the period from 1986 to 2015. Acute
kidney injury was classified according to
Kidney Disease Improving Global Outcomes criteria. We analyzed medical records of patients. Results: 31 patients were included with mean age of 65.41 years
and gender ratio M/F at 0.93. Diabetes was type 2 in 97% of cases. Mean
previous creatinine clearance was 39.33 ml/min/1.73 m2. Drugs involved were blockers of renin-angiotensin system (35%), aminoglycosides
(16%), non-steroidal anti-inflammatory
(16%), diuretics (13%), lipid-lowering agents (10%), rifampicin (6%) and ifosfamide (3%). Extracellular dehydration
was present in nine cases (29%). Main drug combinations were with
diuretics in 16 cases (52%) and with ACE inhibitor or ARB in eight cases (26%). Oligo anuria was observed in 5 cases
(16%). Proteinuria with urine strips was objectified in 25 cases (81%). Acute
kidney injury was grade 3 in 24 cases (77%), grade 2 in three cases (10%) and
grade 1 in four cases (13%). Renal survival at 102 months was 57%. Identified renal
prognosis factors were serum phosphorus >1.47 mmol/l
(p = 0.01), proteinuria at urine strips (p = 0.042), dehydration (p = 0.013), oral antidiabetic treatment (p =
0.038), intravenous rehydration (p = 0.021) and insulin (p = 0.006). Conclusion: Drug-induced acute kidney
injury is potentially serious in diabetics. Prevention is essential to improve
the prognosis of this renal damage.