Drug-induced kidney injury: A large case series from the Berlin Case-Control Surveillance Study

Objectives: Drug-induced kidney injury (DIKI) may affect patients regardless of their baseline kidney function. Therefore, this study evaluated DIKI in patients with or without previous chronic kidney disease (CKD). Materials and meth- ; Potential DIKI cases were ascertained using the network of the Berlin Case-Control Surveillance Study in all 51 Berlin hospitals from April 2010 until December 2011. Via face-to-face interviews and medical chart reviews, information on all previous drug intake, comorbidities, and demographics was gathered. Included were adult patients with a new diagnosis of acute kidney injury or an acute-on-chronic kidney injury, and with an at least "possible" drug etiology based on the standardized causality assessment of the World Health Organization. Excluded were patients with prerenal or postrenal etiology, bacterial interstitial nephritis, or previous renal transplantation. Results: Overall, 143 patients with DIKI were included in the study (mean age 68.4 +/- 15.6 years). Of those, 77 (54%) had pre-diagnosed CKD. The most common symptom at onset was anuria/ oliguria, while 73 patients (51%) underwent renal replacement therapy, and 11 patients (8%) died. Cardiovascular drugs, such as furosemide, torasemide, hydrochlorothiazide, and ramipril (33%), systemic anti-infectives, such as vancomycin (23%), and musculoskeletal drugs, such as ibuprofen and diclofenac (15%), were most commonly causal for DIKI. Of the 37 patients with DIKI caused by nonsteroidal anti-inflammatory drugs (NSAIDs), 20 (54%) had prediagnosed CKD. Conclusion: Nephrotoxicity can be caused by numerous medications, highlighting the importance of increased vigilance among physicians. Moreover, NSAIDs seem to exhibit nephrotoxic properties even in patients with normal baseline kidney function.