Q&A

Q: Why can't I take cold medicine for kidney disease?

A: Many cold remedies can worsen kidney damage!

So, besides cold medicines, what other medicines are also known to damage the kidneys? Common medications that can cause kidney damage are pictured below (click for a larger image):

All of these drugs, above, are clearly nephrotoxic, i.e., capable of damaging the kidneys or aggravating the burden on the already damaged kidneys!

However, many of these are injectable medications and need to be used under a doctor's supervision.

We should be more concerned about oral medications, i.e., which medications taken at home are nephrotoxic!

The three most commonly used types of kidney-damaging oral medications

-01. Antipyretics and analgesics

Antipyretics and analgesics are mainly aspirin, acetaminophen (an ingredient in most cold remedies on the market), and indomethacin (anti-inflammatory pain), which are non-steroidal anti-inflammatory drugs.

Many people do not like to see a doctor for colds, fever or pain, and will take medicines privately, not knowing that such medicines are very harmful to the kidneys, and even more so for patients with kidney disease, they should not take them privately!

-02. Antibiotics

Antibiotics are mainly used to treat infections caused by viruses, bacteria and other microscopic pathogens, etc. Among their causes of kidney damage, beta-lactam antibiotics are the most common, including cephalosporins and penicillins.

Cephalosporin has been updated to four generations, kidney injury to the first and second generation (cefadroxil, cefazolin, ceftizidime) is the main, the third and fourth generation has rarely appeared in the reports of kidney injury. However, it is important to note that you should never drink alcohol when taking cephalosporin!

-03. Chinese medicine

Kidney injury by Chinese medicines has been reported to be most common in Chinese medicines containing aristolochic acid, such as Guanmutong, Guangfengxian, Aristolochia, Qingmuxiang, Tianxianteng, Muwangxian, Xinxin, Seeking Bone Wind, and Weilingxian, among others.

The use of medication is an exacting science!

Not only should we consider the nephrotoxicity of the drugs, but we also need to strictly grasp the indications, contraindications, precautions and adverse reactions of the drugs, so that we can achieve the rational use of drugs.

Therefore, for us kidney patients, even if it is a cold or fever, this kind of seemingly "trivial" is best to take medication under the guidance of a doctor!

References:

[1] Chen Yi-Pu. Attention to renal damage of drugs (a review)[J]. China Medical Journal, 2008, 10(6):810-811.

[2] Meng Zhaoqun. These drugs are easy to hurt the kidney[J]. Family medicine, 2015(8):24-24.

[3] Zhou P. Drug-induced renal damage[J]. Xinjiang Medicine, 2013, 43(8):7-9.

[4] Anonymous. Warnings against three types of herbal medicines that can cause kidney damage[J]. Capital Food and Medicine, 2015(3).

If you have questions about kidney disease or want to know more about kidney disease health knowledge, you can pay attention to the WeChat public number: lovekidney.com!

Auntie Li is 52 years old, not long ago, she came to the hospital for checkups due to the initial swelling of both lower limbs. After the results came out, Auntie Li was shocked. Originally, she worked a year ago in a pharmaceutical company, in order to "rosy cheeks, smooth bowel movements", they took the opportunity to work, every day from the factory to take some of the heat detoxification of traditional Chinese medicine home to take. Unbeknownst to take, but caused a kidney function lesion.

Inappropriate use of drugs can also cause acute kidney injury

Acute kidney injury, mainly manifested as acute renal decompensation, is triggered by a variety of factors, anything that can cause kidney damage can cause acute kidney injury, including incorrect use of medication.

The following types of kidney damaging drugs have been found:

Aminoglycoside antibiotics such as gentamicin;

Non-steroidal anti-inflammatory drugs such as anti-inflammatory painkillers;

Antineoplastic drugs, contrast agents, diuretics;

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Clinically, there are several types of factors that induce acute kidney injury, mainly pre-renal, post-renal and renal diseases. Among them, pre-renal is due to the fact that when blood is perfused into the kidneys, it forms urine through filtration and then comes out. If urine cannot come out, it is likely that acute kidney injury is caused by insufficient perfusion of the kidneys.

Postrenal, on the other hand, is acute kidney injury due to obstruction; malformed kidney injury caused by renal diseases, including renal vascular disease, nephritis, nephrotic syndrome, and nephrotoxicity.

Kidneys are the main excretory organs of the body. In addition to this, the kidneys secrete a variety of biologically active substances, such as renin and erythropoietin. Therefore, the integrity of kidney function is closely related to the balance of the body's internal environment, and drug damage to the kidneys will lead to some functional impairment.

The kidneys passHow urine is formedTo excrete metabolic waste from the body. In other words, the kidneys excrete the waste produced in our body, theAll garbage goes through the kidneys.Excess medication that is absorbed by the body also comes to the kidneys and is then eliminated from the body through the kidneys.

It's like a long time.It's like a kettle that rusts., the more drugs that pass through the kidneys, the more drug waste that accumulates within our kidneys and becomes toxic.

So what are the drugs that can cause nephrotoxicity?

nonsteroidal anti-inflammatory drug (NSAID)

Therapeutic drugs that can cause kidney damage are nonsteroidal anti-inflammatory drugs such asAcetaminophen, aspirin, ibuprofen, indomethacinetc.

Use of non-steroidal anti-inflammatory drugs(say the) leastcan causeThree different typesThe nephrotoxicity of the

The first, usinghigh doseNon-steroidal anti-inflammatory drugs several hours later can cause aacute renal failurewhich is characterized by decreased renal blood flow and glomerular filtration rate and oliguria.Often reversible after stopping the drug。

The second, nonsteroidal anti-inflammatory drugs especiallyparacetamolUse for more than three years can result inIrreversible nephrotoxicity, called analgesic nephropathy. The primary damage in this nephropathy isPapillary necrosis with chronic interstitial nephritis.

In the third type, interstitial nephritis, which is less common, patients usually have elevated serum creatinine with proteinuria. At this timeIf NSAIDs are discontinued, renal function improves within 1 to 3 months.

aminoglycoside antibiotic

Nephrotoxicity of aminoglycoside antibiotics occurs due to the fact that this class of drugs is mainly excreted via the kidneys and in the renal cortex(b) Resulting from accumulation.The first signs of poisoning arePolyuria with difficulty concentrating urineThe subsequent emergence ofUrine protein, tubular urineIn severe cases, it can occurAzotemia and anuriaetc.

Its incidence is thusStreptomycin < gentamicin < kanamycin < neomycin.When such drugs are combined with, for example, aCefthiophene, Cefazolin, Amphotericin B或vancomycin (antibiotic)joint use，May increase the occurrence of nephrotoxicity.

first-generation cephalosporins

Cefthiophene and cefazolin are potentially nephrotoxic when applied in high doses.

Other classes of drugs.

Aristolochic acid, cisplatin, cyclosporine, tetracyclines.

Long-term use of tetracyclines in high doses can exacerbate pre-existing renal insufficiency and affect amino acid metabolism, thereby increasing azotemia, with most severe cases occurring in theTherefore, it should be used with caution in pregnant women, especially those with renal insufficiency.

Kidney is the second only to the liver drug metabolism organ, renal insufficiency will appear a variety of metabolites, drugs or poisons in the body accumulation, causing water, electrolyte and acid-base balance disorders and renal endocrine dysfunction, resulting in multi-organ dysfunction.

Common drugs with nephrotoxicity are:

NSAIDs are drugs with analgesic and anti-inflammatory properties that can cause AKI (Acute Kidney Injury) by weakening renal vasodilatation. Risk factors include CKD (Chronic Kidney Injury), heart failure, and drug induced, with the risk of AKI increasing with higher doses.

Antimicrobials: Aminoglycosides (neomycin has the most severe renal damage, gentamicin damage is also more pronounced), about 90% of which are excreted from the kidneys in the prototype form, can cause alterations in renal tubular cellular structure and function, and ultimately lead to acute tubular necrosis. Penicillin and cephalosporins, penicillins cause acute interstitial nephritis due to allergic reactions, can also lead to hypokalemia. The glycopeptide antibiotic vancomycin increases the nephrotoxicity of aminoglycosides. Amphotericin B causes renal injury mainly due to alterations in glomerular blood flow. Quinolones may show mild nephrotoxic reactions manifested by renal edema and mild inflammation of the renal tubules. Sulfonamides may show crystalluria producing hematuria, renal colic and even acute renal failure [1].

Anti-tumor agents such as cisplatin, methotrexate, doxorubicin.

Antivirals such as acyclovir.

Angiotensin system inhibitors captopril, enalapril, etc. Immunosuppressive drugs cyclosporine, tacrolimus.

The anti-osteoporotic drug diphosphonates as well as various types of diuretics, radiographic contrast agents, and traditional Chinese medicines (Lei Gong Teng, Bambusa, Guan Mutong, Centipede, etc.) are nephrotoxic [2].

bibliography

[1] Li JJ. Research and analysis of risk factors, occurrence mechanism, prevention and treatment methods of acute kidney injury caused by nonsteroidal anti-inflammatory drugs[J]. North Pharmacy,2017,14(08):185+184.

[2] Liu Shijing. Overview of nephrotoxic drugs[J]. Chinese Community Physician,2010,26(22):10.

Drugs.com authoritative interpretation, unauthorized reproduction, plagiarism will be prosecuted

I'll also talk about a drug that is currently very commonly used in this country, but actually has some dangers (not limited to liver and kidney impairment) .

Bismuth, commonly used in gastroenterology, the most commonly used bismuth agents are bismuth potassium bismuth rafate, bismuth colloidal pectin and bismuth subsalicylate. In recent decades, it has been widely used in the treatment of peptic ulcer, eradication of Helicobacter pylori (Hp), and prevention and treatment of diarrhea.
However, the controversy over the pros and cons of bismuth in clinical use continues, and the understanding and application of it is in a state of flux.

After being absorbed by the human body, bismuth agent is mainly distributed in the kidney, brain, liver, spleen and bones, which has certain toxic effects on these organs, especially in the primary health care institutions where there is irrational use of medication, so there is a potential risk of medication.
In the 1970s, France, Australia, Brazil and other countries began to report bismuth encephalopathy after taking bismuth, especially in France from 1972 to 1977, there was an epidemic of fatal encephalopathy caused by the use of bismuth in large doses and for long periods of time.

The use of bismuth has since caused panic and attention and has faded from clinical use.

However, bismuth has made a comeback since 1985 when it was discovered that it could kill Helicobacter pylori (HP). There is an industry consensus on bismuth as a member of the quadruple therapy in the treatment of Hp eradication.

At the same time, there have been many reports of related side effects caused by it.

• Neurologic: Bismuth encephalopathy was first recognized in Australia in 1973, and has since been reported in France and Western Europe. 945 cases of bismuth encephalopathy have been reported in France in 1979, of which 72 died. In Australia, more than 1,000 cases of bismuth encephalopathy have been reported.
  
• Urinary system: bismuth during the regular dosage (480mg/d) bismuth at 4 weeks blood concentration of 7.0ug / L, the daily excretion rate through the kidneys is 2.6%, stop the drug 60d before the concentration of bismuth in the urine to return to the level before the use of the drug, long-term use of bismuth can cause renal failure.
  
• Skeletal Muscular System: Adverse skeletal reactions often occur at different sites and are associated with excessive concentrations of bismuth in the bone. More common is osteoarthrosis, often with unilateral or bilateral shoulder pain as a precursor symptom.
  Therefore, over the years, many experts have proposed that bismuth should be used more often in combination with antimicrobial drugs and acid-suppressing drugs as remedial therapy for Hp eradication. And it should not be introduced as a first-line program (conventional quadruple therapy), much less advocated as a gastric mucosa protector alone.

For this problem, Director Niu Tieming of the Department of Nephrology at Shenyang Red Cross Hospital expressed deep concern.

It is currently accepted in the medical community that someCold medicine, painkillers and herbsIt is damaging to the kidneys. However, the general public knows little about this, and when prescribing medication to patients, doctors often lack adequate and necessary reminders in a timely manner.

This also leads to a direct consequence that some patients do not take their medication as prescribed, and taking a certain medication for a long period of time becomes a habit, which may result in unknowing kidney damage.

There are also some old people, used to go to the pharmacy to prescribe their own medicines, lack of full understanding of the pharmacology of the drug properties of the drug damage, so this damage is also often silent.

Ask how many people around you take medication and only read the instructions on how many times a day to take a few tablets, without looking at the harm.

The scary thing is that not all kidney damage will be detectable by a routine urine test.

Director Liu reminded, in addition to attention in daily life to check the urine with or without turbidity, foam color changes and other abnormalities, regular body check urine routine, but also pay attention to the examination of kidney function.

Kidney function is similar to liver function, and the cost of the test is not high, about less than $30, but kidney function is not included in the program of the physical examination organized by many organizations.

Let's try to ask, how many people around us do not have the habit of regular medical check-ups? How many people do not even go to the free medical checkups organized by their units?

Director Niu extraordinarily also mentioned patients with vascular disease, who, during coronary angiography, ingested the body'scontrast mediumIt is a substance that is clearly known to be damaging to the kidneys.

Patients with cardiovascular and cerebrovascular diseases combined with nephropathy are often encountered in the clinic and need to go to the consultation. Director Niu analyzed that the damage of contrast media may be a reason for the prominence of nephropathy in these patients.

The damage of drugs to the kidneys can fully reflect the common saying that "drugs are three times poisonous", so when taking medication, we must follow the doctor's instructions, and have adequate communication and exchange with the doctor.

Let's start with a general overview of the currently known nephrotoxic drugs in the clinic:

1. Antibiotics: streptomycin, gentamicin, tobramycin, amikacin, rifampicin, vancomycin, amphotericin B, etc.

2. Antipyretic and analgesic drugs: Indomethacin, Ibuprofen, Propoxyphene, Naproxen, Acetaminophen, Anacin, etc.

3. Tumor chemotherapeutic drugs: cisplatin, methotrexate, procamptothecin, mitomycin-C, nitrosoureas, 5-fluorouracil and so on.

4. Antiepileptic drugs: trimethoprim, phenytoin sodium, etc.

5. Angiographic agents.

6. Herbal medicine

Life, antibiotics and antipyretic and analgesic drugs are more commonly used, some of them are abused in a mess, if they would have had a kidney disease, be sure to inform the doctor in advance, to avoid the kidneys of the 2 strikes; the other in addition to the Chinese herbs, generally by specialists to prescribe the drug to control, the control is still relatively stringent, relatively speaking, safer.

The kidneys are the main excretory organs of the body and are particularly susceptible to the effects of drugs, some of which can have direct toxic effects on the kidneys or cause kidney damage through allergic reactions. The clinical manifestations of drug-induced renal damage are various, including back pain, change of urine color, change of urine volume, increase of foam in urine which is not easy to dissipate, edema of eyelids or lower limbs, and anemia and high blood pressure; some patients have non-specific manifestations, such as fatigue, loss of appetite, etc.; and, of course, there are some people who have no feeling whatsoever, and it is only during the medical checkups that they find out that their kidneys are out of order.

In clinical practice, there are a variety of drugs that can cause pharmacogenetic renal damage, the main ones being the following:

I. Antibiotics

1. Aminoglycosides: gentamicin, amikacin, natamycin

2. Beta-lactams: 1st generation cephalosporins, imipenem

3. Polymyxins: Polymyxin B

4. Sulfonamides: compound sulfamethoxazole

5. Quinolones: levofloxacin, trevafloxacin

6. Glycopeptides: vancomycin

7. Amphotericin B

Second, non-steroidal anti-inflammatory drugs: ibuprofen, prednisone, aspirin, compounded aspirin (APC), aminopyralid, acetaminophen and so on.

III. Tumor chemotherapy drugs

Cisplatin, methotrexate, mitomycin C, and 5-fluorouracil.

Fourth, anti-epileptic drugs: sodium phenytoin and so on.

V. Anesthetics: ether, methoxyflurane, etc.

VI. Metals and Complexing Agents: Penicillamine, Ettarates, etc.

VII. Various angiographic agents

VIII. Other western drugs: cyclosporine A, mephedrone, allopurinol, mannitol, mercurialis, heroin, low molecular dextrose, etc.

IX. Traditional Chinese medicine

Nearly 50 herbs have been found to be toxic to the kidneys, and there are three main categories.

Botanical Chinese medicine: Lei Gong Teng, Cao Wu, Mutong, Juniperus, Motherwort, Cang Er Zi, Neem Peel, Smallpox Powder, Petunia, Golden Cherry Root, Shibei Mu, Aristolochia, Shijiazhuang, Ba Dou, Aloe vera, Iron-footed Weiling Xian, Great Maple Seed, Shan Ci Mushroom, Yang Jinhua, Drilling Fung, Bamboo Shoots, Big Green Leaf, Zedoary, Fenpang, Gan Sui, Qianlong, Cloves, Hooker Vine, Bone-setters, Bai Tu Hao Weng, Short-ground Tea, Bitter Ginseng, Tou Niu Knees, and so on. , Wang Jiang Nan Zi, Cotton Seed, Wax Plum Root and so on.

Animal herbal medicines: Spotted fibers, fish guts, whole scorpions, centipedes, snake venom and so on.

Mineral Chinese medicine: Arsenic (arsenic, arsenic, andrographis, alum), mercury (cinnabar, mercuric, light powder), lead (pbd) and other minerals (alum) and so on.

Many people are clear that bad kidneys should be regulated in time, and tend to choose Chinese medicine to regulate the body. It is worth noting that, to regulate the kidneys should not take drugs on their own. The medicine is three times poisonous, it is understood that there are three main categories of Chinese medicine that may lead to kidney damage.

The first category is plant-based herbs, such as Lei Gong Teng, Oleander, Cao Wu, Croton, Aloe Vera, and so on.

The second category is animal-based herbal medicines, such as zebra fiber, fish guts, seahorses, centipedes, snake venom, and so on.

The third category is mineral-based traditional Chinese medicine containing arsenic, mercury and lead., such as arsenic, light powder, lead powder, andrographis, mercury, alum, and so on.

In addition to Chinese herbs, painkillers and cold medicines sold on the market can also hurt the kidneys to a greater or lesser extent.

Therefore, there are symptoms of unhealthy kidneys need to go to the hospital in time for a comprehensive examination.On the one hand, don't listen to biased prescriptions and don't take medication without a doctor's prescriptionAt the same time, you should know what are the side effects of the antibiotics and painkillers prescribed by your doctor, and try to choose the drugs that are less damaging to your kidneys. On the other hand, do not use drugs for a long period of time, large doses and repeated use of drugs. If you need Chinese medicine treatment, avoid herbs that are not good for your kidneys, and go to a specialist for open access to medicines.

What are the medicines that hurt the kidneys

Many medications can cause kidney damage, including Chinese herbs (aristolochia, guanmutong, etc.), and Western medications (vancomycin, anti-tuberculosis drugs, etc.).

(1) Many Chinese medicines have damaging effects on the kidneys, such as Aristolochia (containing aristolochic acid), Guanmutong, Guangpengji, Lei Gongteng, Zangyi, Arsenicum, Cinnabar, Mercury, and Andrographis, and so on. In the clinical use of these drugs, it is necessary to strictly grasp the indications, master the dosage and the time of taking the drug, especially some patients suffering from kidney disease, it is best to prohibit the use of drugs.

(2) Western drugs that often cause kidney damage include antibiotics, including aminoglycosides, vancomycin, anti-tuberculosis drugs (such as streptomycin), etc.; there are also antipyretic and analgesic drugs, diuretics, dehydrating agents, mannitol, contrast agents, immunosuppressants, chemotherapeutic agents, and so on.

This content was reviewed by Wang Xingqiao, Deputy Chief Pharmacist, Department of Pharmacy, Hubei Provincial Hospital of Integrative Medicine.

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