• Vol. 38 No. 3, 240–250
  • 15 March 2009

Drug-induced Kidney Disease – Pathology and Current Concepts

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ABSTRACT

The kidneys can be damaged by a large number of therapeutic agents. The aim of this article is to discuss the pathological features of drug-induced renal disease as diagnosed by kidney biopsy. The literature is reviewed and cases seen by the authors that have a known drug association are analysed. Mechanisms of injury are varied and all renal structures may be affected. The tubulointerstitial compartment is most frequently involved, but glomerular and vascular lesions are seen in a significant proportion of cases.


Departing from the usual account of drug-induced renal disease according to the specific type of drug, we divide this discussion into 3 main areas – glomerular injury, vascular injury and tubulointerstitial changes. In doing so, more emphasis will be placed on morphological findings although functional toxicity (with little or no structural abnormalities detected by routine techniques) plays an equally important role in certain classes of drugs. After diabetes mellitus and hypertension, glomerulonephritis, autosomal dominant polycystic kidney disease and interstitial nephritis account for most of the causes of chronic kidney disease in the United States and other developed countries.1 In the United States Renal Data System 2006 Annual Data Report, “analgesic abuse” and “nephropathy/other agents” were the only 2 primary diagnoses that specifically classify drugs or chemicals as being the causes of end-stage renal disease (ESRD). The true incidence of drug-induced acute and chronic interstitial nephritis is probably underestimated as interstitial nephritis is a non-specific finding in chronically scarred kidneys. Furthermore, the tubulointerstitium is not the only renal compartment involved with this type of injury.

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