Drug-induced glomerular disease: direct cellular injury

Clin J Am Soc Nephrol. 2015 Jul 7;10(7):1291-9. doi: 10.2215/CJN.00860115. Epub 2015 Apr 10.

Abstract

The potential of medications to cause kidney injury is well known. Although nephrotoxicity is most commonly associated with injury in the tubulointerstitial compartment as either acute tubular necrosis or acute interstitial nephritis, a growing body of literature has also highlighted the potential for drug-induced glomerular lesions. This review surveys the three primary patterns of drug-induced glomerular diseases stratified by the cell type at which the glomerular lesion is focused: visceral epithelial cell (or podoctye) injury, endothelial cell injury, and mesangial cell injury. A number of commonly prescribed medications, including IFNs, bisphosphonates, nonsteroidal anti-inflammatory drugs, antiplatelet agents, and antiangiogenesis drugs, that are both prescribed and available over the counter, have been implicated in these iatrogenic forms of glomerular disease. Recognition of these drug-induced etiologies of glomerular disease and rapid discontinuation of the offending agent are critical to maximizing the likelihood of renal function recovery.

Keywords: GN; drug nephrotoxicity; glomerular disease.

Publication types

  • Review

MeSH terms

  • Animals
  • Drug-Related Side Effects and Adverse Reactions / diagnosis
  • Drug-Related Side Effects and Adverse Reactions / etiology*
  • Drug-Related Side Effects and Adverse Reactions / physiopathology
  • Drug-Related Side Effects and Adverse Reactions / therapy
  • Endothelial Cells / drug effects
  • Endothelial Cells / pathology
  • Epithelial Cells / drug effects
  • Epithelial Cells / pathology
  • Glomerulonephritis / chemically induced*
  • Glomerulonephritis / diagnosis
  • Glomerulonephritis / physiopathology
  • Glomerulonephritis / therapy
  • Humans
  • Kidney Glomerulus / drug effects*
  • Kidney Glomerulus / pathology
  • Kidney Glomerulus / physiopathology
  • Mesangial Cells / drug effects
  • Mesangial Cells / pathology
  • Prognosis
  • Risk Assessment
  • Risk Factors