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Describe how kidney disease can predispose a client to cumulative and toxic adverse effects of medications.

Describe how kidney disease can predispose a client to cumulative and toxic adverse effects of medications.

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First, high RBF increases drug delivery to the kidney. High metabolic rates of cells increase risk for nephrotoxicity with certain drugs. Renal biotransformation of drugs to toxic metabolites and ROS overwhelms local anti-oxidants. Increased concentration of drugs in the medulla and interstitium causes nephrotoxicity.

Many non-essential elements have nephrotoxic activity. Chronic injury can involve direct tubular damage, activation of mediators of oxidative stress, genetic modifications that predispose poor cardiovascular outcomes, as well as competitive uptake and element mobilization with essential elements, found to be deficient in CKD. Cardiovascular disease is the most common cause of mortality among CKD patients. Oxidative stress, a common denominator of both deficient and excess element body constitution, underlies many pathological derivatives of chronic kidney disease. Bone disorders, hematological dysfunction and dysregulation of acid-base balance are also prevalent in kidney patients. The largest contribution of toxic element body burden results from environmental exposure and lifestyle practices. However, standard medical therapies may also potentiate toxic element accumulation and re-injury of vulnerable tissue.

Humans may be exposed to toxic elements through water, air or consumption of contaminated food products. In Japan, “Itai Itai” disease occurs as a result of cadmium (Cd) poisoning from consumption of Cd-contaminated rice. It is characterized by several health effects, including severe kidney damage.In Jamaica, Cd levels in kidney and liver tissue samples were highest in study participants from central Jamaica, where environmental and dietary exposure to Cd was also high.6 Naturally occurring Cd measured as high as 409 mg/kg in soil.7Animal studies performed in the same area confirmed a ten-fold accumulation of Cd in the kidney compared to samples from non-polluted areas.In other studies, study subjects with a high level of occupational exposure to lead have shown association with cellular changes, higher creatinine levels and renal injury.Epidemiological studies investigating mercury exposure and CKD have been less clear.

Other toxic elements such as aluminium (Al), silica (SiO2) and strontium (Sr) are eliminated from the body via the kidney. Some of these can be nephrotoxic, and a dysfunctional kidney increases retention of these heavy metals, thus perpetuating further damage.Apart from the tendency to accumulate within the kidney, hazardous elements are also actively reabsorbed after glomerular filtration via metal transporters, in ways still poorly understood. It is through these mechanisms that some postulate a disruption in the normal re-absorption of essential micro-nutrients from urine. The long half-life of these elements, their affinity to absorb and accumulate within the bone and kidney, disruption of normal hormonal processes and essential trace elemental and ligand interactions are all factors increasing retention within the body and potentiating toxicity in the kidney.

5 Drugs You May Need to Avoid or Adjust if You Have Kidney...

  • Cholesterol medications. The dosing of certain cholesterol medications, known as "statins", may need to be adjusted if you have chronic kidney disease.
  • Pain medications. ...
  • Anti-microbial meds. ...
  • Diabetes medications. ...
  • Upset stomach/antacid medications.
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