Today there is a patient consultation, let me help him analyze the test list, the patient is a young man, suffering from nephrotic syndrome, urine protein has been yin for a long time, but recently creatinine has been elevated, has reached the upper limit of the normal range, ask the local hospital can not say why. So I was asked, and by asking about his medication, I found a clue, that is, the use of pantoprazole sodium enteric-coated tablets for more than 1 and a half years, when the drug was used to prevent gastric mucosal damage caused by a large number of hormones. But this drug or this type of drug, if taken for more than 1 month, may lead to kidney damage, so I suggest that he stop the drug observation, although can not be completely sure whether it is the problem of this drug, but at present can not find other reasons, after a period of follow-up to see.
The kidney is an important organ that metabolizes and excretes metabolites, chemicals and various drugs, and is also the main target organ for drug damage. Some drugs can directly cause kidney damage, and some can accelerate the rate of kidney failure. Therefore, today I want to talk about this problem, talk about what drugs hurt the kidneys, and let's see if they are applying, or have been applied, no matter which one, it is recommended that you be cautious.
1. Nonsteroidal anti-inflammatory analgesics: indomethacin, ibuprofen, phenylbutazone, celecoxib, acetaminophen, aspirin, aminopyrine, phenacetine, etc.
2. Antibiotics and other chemical drugs: amphotericin B, neomycin, first and second generation cephalosporin, ampicillin and methicillin, gentamicin, streptomycin, kanamycin, tobramycin, vancomycin, sulfonamides, etc.
3. Various angiography agents
4. Immunosuppressants: such as cyclosporine, tacrolimus, triptolide, methotrexate.
5. Antitumor drugs: such as cisplatin, methotrexate, mitomycin, 5-fluorouracil, brilliant mycin, cytarabine.
6. Anti-epileptic drugs: such as trimethyldiketone and phenytoin.
7. Anesthetics: such as ether and methoxyflurane.
8. Metals and complexing agents: such as penicillamine, itarate.
9. Chinese herbal medicine:
At present, the study of the toxicity of Chinese medicines has found that nearly 50 kinds of Chinese medicines are toxic to the kidneys. There are three types of Chinese medicines that can cause kidney damage.
The first category is plant-based Traditional Chinese Medicine: Lei Gong Teng, Cao Wu, Mu Tong, Junjun, Motherwort, Cang Er Zi, Bitter Neem Peel, Smallpox Pollen, Morning Glory Seed, Golden Cherry Root, Shi Bei Mu, Aristolochia, Shi Jing Mustard, Croton, Aloe Vera, Iron Foot Wei Lingxian, Big Maple, Mountain Ci Mushroom, Yang Jinhua, Drill Wind, Oleander, Big Green Leaf, Ze Diarrhea, Fangji, Gansui, Thousand Mile Light, Cloves, Hook Vine, Bone Fat, White Head, Dwarf Tea, Bitter Ginseng, Soil Cow Knee, Wangjiang Nanzi, Cotton Seed, Wax Plum Root, etc.
The second category is animal chinese medicine: cantharid, fish gall, whole scorpion, centipede, snake venom, etc.
The third category is mineral Traditional Chinese medicine: arsenic (arsenic, arsenic, male yellow, red alum), mercury containing (cinnabar, mercury, light powder), lead containing (lead dan) and other minerals (alum) and so on.
10. Proton pump inhibitors: such as pantoprazole, omeprazole, esomeprazole, etc
11. Others: such as allopurinol, mannitol, heroin, low molecular weight dextran, etc.
The common types of drug-induced kidney injury and their corresponding kidney injury drugs are shown in the following table:
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Pathological type
Common drugs
Thrombotic microangiopathy
Vincristine, cisplatin, mitomycin, vancomycin, nonsteroidal anti-inflammatory drugs, interferon, cocaine, etc
vasculitis
Interferon, quinine, cefotaxime, penicillinamine, biologics, hydralazine
Membranous nephropathy
Gold preparations, nonsteroidal anti-inflammatory drugs, penicillinamines
Micropathy of the glomeruli
Gold preparations, NSAIDs, lithium, interferon, rifampicin
Acute tubular necrosis
Cisplatin, aminoglycosides, tetracyclines, amphotericin B, NSAIDs, contrast agents, rifampicin, traditional Chinese medicine (see above)
Acute interstitial nephritis
Sulfonamides, vancomycin, rifampicin, proton pump inhibitors, NSAIDs
Here's a point: for any drug, talking about side effects aside from the dosage is hooliganism. For example, watermelon is low in potassium, but the potassium intake will increase when you eat more; bananas are high in potassium, but eating a small half root will not lead to high potassium. The same is true of medication, some drugs in the short term conventional dosage is no problem, and toxic side effects are also a probability, will not appear 100%.
So, how to prevent it?
1. Be cautious about folk remedies or secret recipes
2. Drink more water to promote the metabolism of drugs in the kidneys and reduce the damage to the kidneys
3. For drugs that are known to be nephrotoxic but must be used, it is necessary to closely observe the changes in urine and kidney function when using, and stop the drug in time once abnormalities are found.
4. The dose needs to be reduced when the elderly and young patients apply the drug.
5. The vast majority of drugs chronic kidney damage is caused by long-term or over-medication, medication must strictly abide by the doctor's instructions, must not increase the dosage of medication and prolong the medication time.
6. Regularly monitor kidney function.
The above content is excerpted from the WeChat public account: the right way of the kidney!