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Džidić-Krivić A, Sher EK, Kusturica J, Farhat EK, Nawaz A, Sher F. Unveiling drug induced nephrotoxicity using novel biomarkers and cutting-edge preventive strategies. Chem Biol Interact 2024; 388:110838. [PMID: 38104745 DOI: 10.1016/j.cbi.2023.110838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/03/2023] [Accepted: 12/15/2023] [Indexed: 12/19/2023]
Abstract
Drug-induced nephrotoxicity is still a significant obstacle in pharmacotherapy of various diseases and it accounts for around 25 % of serious side-effects reported after drug administration. Furthermore, some groups of drugs such as nonsteroidal anti-inflammatory drugs, antibiotics, antiviral drugs, antifungal drugs, immunosuppressants, and chemotherapeutic drugs have the "preference" for damaging the kidney and are often referred to as the kidney's "silent killer". Clinically, the onset of acute kidney injury associated with drug administration is registered in approximately 20 % of patients and many of them develop chronic kidney disease vulnerability. However, current knowledge about the mechanisms underlying this dangerous phenomenon is still insufficient with many unknowns. Hence, the valuable use of these drugs in clinical practice is significantly limited. The main aim of this study is to draw attention to commonly prescribed nephrotoxic drugs by clinicians or drugs bought over the counter. In addition, the complex relationship between immunological, vascular and inflammatory events that promote kidney damage is discussed. The practical use of this knowledge could be implemented in the engineering of novel biomarkers for early detection of drug-associated kidney damage such as Kidney Injury Molecule (KIM-1), lipocalin associated with neutrophil gelatinase (NGAL) and various microRNAs. In addition, the utilization of artificial intelligence (AI) for the development of computer algorithms that could detect kidney damage at an early stage should be further explored. Therefore, this comprehensive review provides a new outlook on drug nephrotoxicity that opens the door for further clinical research of novel potential drugs or natural products for the prevention of drug-induced nephrotoxicity and accessible education.
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Affiliation(s)
- Amina Džidić-Krivić
- Department of Neurology, Cantonal Hospital Zenica, Zenica, 72000, Bosnia and Herzegovina; International Society of Engineering Science and Technology, Nottingham, United Kingdom
| | - Emina K Sher
- Department of Biosciences, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, United Kingdom.
| | - Jasna Kusturica
- Faculty of Medicine,Univerisity of Sarajevo, Sarajevo, 71000, Bosnia and Herzegovina
| | - Esma K Farhat
- International Society of Engineering Science and Technology, Nottingham, United Kingdom; Department of Food and Nutrition Research, Faculty of Food Technology, Juraj Strossmayer University of Osijek, Osijek, 31000, Croatia
| | - Asma Nawaz
- International Society of Engineering Science and Technology, Nottingham, United Kingdom; Department of Biochemistry, University of Agriculture, Faisalabad, 38040, Pakistan
| | - Farooq Sher
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, United Kingdom.
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Mody H, Nair S, Rump A, Vaidya TR, Garrett TJ, Lesko L, Ait-Oudhia S. Identification of Novel and Early Biomarkers for Cisplatin-induced Nephrotoxicity and the Nephroprotective Role of Cimetidine using a Pharmacometabolomic-based Approach Coupled with In Vitro Toxicodynamic Modeling and Simulation. J Pharm Sci 2024; 113:268-277. [PMID: 37992870 DOI: 10.1016/j.xphs.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
Cisplatin is widely used for the treatment of various types of cancer. However, cisplatin-induced nephrotoxicity (CIN) is frequently observed in patients receiving cisplatin therapy which poses a challenge in its clinical utility. Currently used clinical biomarkers for CIN are not adequate for early detection of nephrotoxicity, hence there is a need to identify potential early biomarkers in predicting CIN. In the current study, a combination of in vitro toxicodynamic (TD) modeling and untargeted global metabolomics approach was used to identify novel potential metabolite biomarkers for early detection of CIN. In addition, we investigated the protective role of cimetidine (CIM), an inhibitor of the organic cation transporter 2 (OCT2), in suppressing CIN. We first characterized the time-course of nephrotoxic effects of cisplatin (CIS) and the protective effects of CIM in a human pseudo-immortalized renal proximal tubule epithelial cell line (RPTEC), SA7K cell line. Secondly, we used a mathematical cell-level, in vitro TD modeling approach to quantitatively characterize the time-course effects of CIS and CIM as single agents and combination in SA7K cells. Based on the experimental and modeling results, we selected relevant concentrations of CIS and CIM for our metabolomics study. With the help of PCA (Principal Component Analysis) and PLS-DA (Projection to Latent Structure - Discriminate Analysis) analyses, we confirmed global metabolome changes for different groups (CIS, CIM, CIS+CIM vs control) in SA7K cells. Based on the criterion of a p-value ≤ 0.05 and a fold change ≥ 2 or ≤ 0.5, we identified 20 top metabolites that were significantly changed during the early phase i.e. within first 12 h of CIS treatment. Finally, pathway analysis was conducted that revealed the key metabolic pathways that were most impacted in CIN.
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Affiliation(s)
- Hardik Mody
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, FL, USA
| | - Sreenath Nair
- Pharmaceutical Sciences Department, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Adrian Rump
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, FL, USA
| | - Tanaya R Vaidya
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, FL, USA
| | - Timothy J Garrett
- Southeast Center for Integrated Metabolomics, University of Florida, Gainesville, FL, USA
| | - Lawrence Lesko
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, FL, USA
| | - Sihem Ait-Oudhia
- Quantitative Pharmacology and Pharmacometrics (QP2), Merck & Co., Inc, Rahway, NJ, USA.
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Parra-Naranjo A, Delgado-Montemayor C, Salazar-Aranda R, Waksman-Minsky N. Bioactivity of the Genus Turnera: A Review of the Last 10 Years. Pharmaceuticals (Basel) 2023; 16:1573. [PMID: 38004438 PMCID: PMC10675026 DOI: 10.3390/ph16111573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Turnera is a genus of plants whose biological activity has been widely studied. The importance of this genus, particularly Turnera diffusa, as a source of treatment for various conditions is evidenced by the large number of new studies that have evaluated its biological activity. Accordingly, the objective of this review was to compile the information published in the last ten years concerning the biological activities reported for Turnera spp. The present work includes 92 publications that evaluate 29 bioactivities and toxicological and genotoxic information on five species of this genus. Among the pharmacological effects reported, the antioxidant, hepatoprotective, neuroprotective, hypoglycemic, and aphrodisiac activities seem more promising. Phytochemicals and standardized plant extracts could offer alternative therapeutic remedies for various diseases. Although several flavonoids, cyanogenic glycosides, monoterpenoids, triterpenoids, and fatty acids have been isolated for Turnera plants, future research should focus on the identification of the main active principles responsible for these pharmacological activities, as well as to perform clinical trials to support the laboratory results.
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Affiliation(s)
| | | | | | - Noemí Waksman-Minsky
- Facultad de Medicina, Departamento de Química Analítica, Universidad Autónoma de Nuevo León, Monterrey 64460, Nuevo León, Mexico; (A.P.-N.); (C.D.-M.); (R.S.-A.)
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Yousif ZK, Koola JD, Macedo E, Cerda J, Goldstein SL, Chakravarthi R, Lewington A, Selewski D, Zappitelli M, Cruz D, Tolwani A, Joy MS, Jha V, Ramachandran R, Ostermann M, Pandya B, Acharya A, Brophy P, Ponce D, Steinke J, Bouchard J, Irarrazabal CE, Irarrazabal R, Boltansky A, Askenazi D, Kolhe N, Claure-Del Granado R, Benador N, Castledine C, Davenport A, Barratt J, Bhandari S, Riley AA, Davis T, Farmer C, Hogarth M, Thomas M, Murray PT, Robinson-Cohen C, Nicoletti P, Vaingankar S, Mehta R, Awdishu L. Clinical Characteristics and Outcomes of Drug-Induced Acute Kidney Injury Cases. Kidney Int Rep 2023; 8:2333-2344. [PMID: 38025217 PMCID: PMC10658426 DOI: 10.1016/j.ekir.2023.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/22/2023] [Accepted: 07/31/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Drug-induced acute kidney injury (DI-AKI) is a frequent adverse event. The identification of DI-AKI is challenged by competing etiologies, clinical heterogeneity among patients, and a lack of accurate diagnostic tools. Our research aims to describe the clinical characteristics and predictive variables of DI-AKI. Methods We analyzed data from the Drug-Induced Renal Injury Consortium (DIRECT) study (NCT02159209), an international, multicenter, observational cohort study of enriched clinically adjudicated DI-AKI cases. Cases met the primary inclusion criteria if the patient was exposed to at least 1 nephrotoxic drug for a minimum of 24 hours prior to AKI onset. Cases were clinically adjudicated, and inter-rater reliability (IRR) was measured using Krippendorff's alpha. Variables associated with DI-AKI were identified using L1 regularized multivariable logistic regression. Model performance was assessed using the area under the receiver operating characteristic curve (ROC AUC). Results A total of 314 AKI cases met the eligibility criteria for this analysis, and 271 (86%) cases were adjudicated as DI-AKI. The majority of the AKI cases were recruited from the United States (68%). The most frequent causal nephrotoxic drugs were vancomycin (48.7%), nonsteroidal antiinflammatory drugs (18.2%), and piperacillin/tazobactam (17.8%). The IRR for DI-AKI adjudication was 0.309. The multivariable model identified age, vascular capacity, hyperglycemia, infections, pyuria, serum creatinine (SCr) trends, and contrast media as significant predictors of DI-AKI with good performance (ROC AUC 0.86). Conclusion The identification of DI-AKI is challenging even with comprehensive adjudication by experienced nephrologists. Our analysis identified key clinical characteristics and outcomes of DI-AKI compared to other AKI etiologies.
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Affiliation(s)
- Zaid K. Yousif
- Division of Clinical Pharmacy, University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical, La Jolla, California, USA
| | - Jejo D. Koola
- Division of Biomedical Informatics, Department of Medicine, University of California, La Jolla, California, USA
- Division of Hospital Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Etienne Macedo
- Division of Nephrology, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Jorge Cerda
- Albany Medical College, Albany, New York, USA
- St. Peter's Hospital Partners, Albany, New York, USA
| | - Stuart L. Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | | | - David Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael Zappitelli
- Department of Pediatrics, Division of Nephrology, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Dinna Cruz
- Division of Nephrology, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | | | - Melanie S. Joy
- University of Colorado School of Pharmacy and Pharmaceutical Sciences and School of Medicine in Aurora, Colorado, USA
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, MManipal Academy of Higher Education, Manipal, India
| | - Raja Ramachandran
- Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Marlies Ostermann
- Department of Critical Care and Nephrology, King’s College London, Guy’s and St Thomas’ Hospital, London, UK
| | - Bhavna Pandya
- Medical and Dental Staff Governor, Liverpool University Hospitals NHS Foundation Trust/Aintree University Hospital, Liverpool, UK
| | - Anjali Acharya
- Jacobi Medical Center, Albert Einstein College of Medicine, The Bronx, New York, New York, USA
| | - Patrick Brophy
- Department of Pediatrics at the University of Rochester School of Medicine and Dentistry, New York, USA
| | | | - Julia Steinke
- Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Josee Bouchard
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Carlos E. Irarrazabal
- Programa de Fisiología, Centro de Investigación e Innovación Biomédica, Universidad de los Andes, Santiago, Chile
| | | | | | - David Askenazi
- Children's of Alabama (UAB-Pediatrics), Birmingham, Alabama, USA
| | - Nitin Kolhe
- Consultant Nephrologist, Royal Derby Hospital, Derby, UK
| | - Rolando Claure-Del Granado
- Division of Nephrology Hospital Obrero No 2 – CNS Cochabamba, Bolivia/Universidad Mayor de San Simón School of Medicine Cochabamba, Bolivia
| | - Nadine Benador
- University of California San Diego, San Diego, California, USA / Rady Children's Hospital, San Diego, USA
| | | | - Andrew Davenport
- University College London, Department of Renal Medicine, Royal Free London NHS Trust London, UK
| | - Jonathan Barratt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Alyssa A. Riley
- Department of Pediatrics, Section of Nephrology, Baylor College of Medicine, Houston, Texas, USA
| | - T.K. Davis
- St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Christopher Farmer
- Centre for Health Services Studies, George Allen Wing, Cornwallis Building, University of Kent, Canterbury, Kent, UK
| | - Michael Hogarth
- Division of Biomedical Informatics, Department of Medicine, University of California, La Jolla, California, USA
| | - Mark Thomas
- Birmingham Heartlands Hospital, Birmingham, Alabama, USA
| | | | - Cassianne Robinson-Cohen
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Tennessee, USA
| | - Paola Nicoletti
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Ravindra Mehta
- Division of Nephrology, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Linda Awdishu
- Division of Clinical Pharmacy, University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical, La Jolla, California, USA
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Aurori M, Andrei S, Dreanca AI, Morohoschi AG, Cotul M, Niculae M, Nan MI, Codea AR, Gal AF. The Nephroprotective Effect of Cornelian Cherry ( Cornus mas L.) and Rowanberry ( Sorbus aucuparia L.) in Gentamicin-Induced Nephrotoxicity on Wistar Rats with Emphasis on the Evaluation of Novel Renal Biomarkers and the Antioxidant Capacity in Correlation with Nitro-Oxidative Stress. Nutrients 2023; 15:4392. [PMID: 37892466 PMCID: PMC10609733 DOI: 10.3390/nu15204392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
In spite of its well-known nephrotoxicity, gentamicin is nonetheless routinely used in humans and animals. However, no adjuvant treatments have been implemented to mitigate this harmful effect. Given this concern, medicinal plants represent a significant reservoir of natural antioxidants that could potentially reduce the renal oxidative stress induced by gentamicin. Therefore, the main objective of this research was to investigate the nephroprotective properties of Cornus mas and Sorbus aucuparia fruits in an experimental model of nephrotoxicity. The 3-week study was performed on male Wistar rats, which were randomly divided into six experimental groups, being subcutaneously treated with 50 mg/kg gentamicin and orally given Cornus mas and Sorbus aucuparia extracts, in doses of 40 mg/kg and 10 mg/kg, respectively. Antioxidant therapy significantly improved the nitro-oxidative stress parameters as well as the specific renal biomarkers KIM-1 and iNAG, demonstrating a considerable renal tubular protective impact. These outcomes were reinforced by biochemical and histopathological enhancements. Nevertheless, neither of the tested extracts succeeded in substantially diminishing BUN levels. Additionally, CysC did not significantly decline following extracts treatment, suggesting that the remedies did not effectively protect renal glomeruli against gentamicin stress. Future studies are required in order to determine the underlying mechanisms of these berries.
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Affiliation(s)
- Mara Aurori
- Department of Preclinical Sciences, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 400374 Cluj-Napoca, Romania; (M.A.); (A.I.D.); (A.G.M.); (M.C.); (M.I.N.); (A.F.G.)
| | - Sanda Andrei
- Department of Preclinical Sciences, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 400374 Cluj-Napoca, Romania; (M.A.); (A.I.D.); (A.G.M.); (M.C.); (M.I.N.); (A.F.G.)
| | - Alexandra Iulia Dreanca
- Department of Preclinical Sciences, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 400374 Cluj-Napoca, Romania; (M.A.); (A.I.D.); (A.G.M.); (M.C.); (M.I.N.); (A.F.G.)
| | - Andreea Georgiana Morohoschi
- Department of Preclinical Sciences, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 400374 Cluj-Napoca, Romania; (M.A.); (A.I.D.); (A.G.M.); (M.C.); (M.I.N.); (A.F.G.)
| | - Mihaela Cotul
- Department of Preclinical Sciences, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 400374 Cluj-Napoca, Romania; (M.A.); (A.I.D.); (A.G.M.); (M.C.); (M.I.N.); (A.F.G.)
| | - Mihaela Niculae
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 400374 Cluj-Napoca, Romania; (M.N.); (A.R.C.)
| | - Monica Irina Nan
- Department of Preclinical Sciences, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 400374 Cluj-Napoca, Romania; (M.A.); (A.I.D.); (A.G.M.); (M.C.); (M.I.N.); (A.F.G.)
| | - Andrei Răzvan Codea
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 400374 Cluj-Napoca, Romania; (M.N.); (A.R.C.)
| | - Adrian Florin Gal
- Department of Preclinical Sciences, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 400374 Cluj-Napoca, Romania; (M.A.); (A.I.D.); (A.G.M.); (M.C.); (M.I.N.); (A.F.G.)
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Acute Kidney Injury in the ICU during Ganciclovir Treatment, an Observational Study. J Clin Med 2023; 12:jcm12051898. [PMID: 36902685 PMCID: PMC10003307 DOI: 10.3390/jcm12051898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023] Open
Abstract
The aim of this study is to investigate the relationship between ganciclovir exposure with TDM and the development of AKI in ICU patients. This retrospective single-center observational cohort study included adult ICU patients treated with ganciclovir who had a minimum of one ganciclovir trough serum level. Patients receiving less than two days of treatment and patients with fewer than two measurements of serum creatinine, RIFLE scores, and/or renal SOFA scores were excluded. Acute kidney injury incidence was assessed with the difference between the final and first values of the renal SOFA score, RIFLE score, and serum creatinine. Nonparametric statistical tests were performed. In addition, the clinical relevance of these results was evaluated. A total of 64 patients were included with a median cumulative dose of 3150 mg. The mean difference in serum creatinine during ganciclovir treatment was reduced by 7.3 μmol/L (p = 0.143). The RIFLE score decreased by 0.04 (p = 0.912), and the renal SOFA score was reduced by 0.07 (p = 0.551). This single-center observational cohort study showed that ICU patients using ganciclovir with TDM-guided dosing did not develop acute kidney injury as measured by serum creatinine, RIFLE score, and renal SOFA score.
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Boivin E, Le Daré B, Bellay R, Vigneau C, Mercerolle M, Bacle A. Long-term lithium therapy and risk of chronic kidney disease, hyperparathyroidism and hypercalcemia: a cohort study. Int J Bipolar Disord 2023; 11:4. [PMID: 36709463 PMCID: PMC9884717 DOI: 10.1186/s40345-023-00286-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/06/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Lithium is well recognized as the first-line maintenance treatment for bipolar disorder (BD). However, besides therapeutic benefits attributed to lithium therapy, the associated side effects including endocrinological and renal disorders constitute important parameters in prescribing patterns and patient adherence. The objectives of this study is to (i) determine whether long-term lithium therapy is associated with a decrease in renal function, hyperparathyroidism and hypercalcemia and (ii) identify risk factors for lithium-induced chronic kidney disease (CKD). METHODS We conducted a single-centered cohort study of adult patients (≥ 18 years) treated with lithium, who were enrolled at Rennes University Hospital in France between January 1, 2018 and June 1, 2020. Required data were collected from the patient's medical records: demographics characteristics (age, sex, body mass index), biologic parameters (GFR, lithium blood level, PTH and calcium), medical comorbidities (hypertension and diabetes), lithium treatment duration and dosage, and length of hospitalization. RESULTS A total of 248 patients were included (mean age: 60.2 ± 16.5 years). Duration of lithium treatment correlated with (i) deterioration of renal function estimated at - 2.9 mL/min/year (p < 0.0001) and (ii) the development of hyperparathyroidism (p < 0.01) and hypercalcemia (p < 0.01). We also noted that patients with lithium blood level > 0.8 mEq/mL had significantly lower GFR than patients with lithium blood level < 0.8 mEq/mL (61.8 mL/min versus 77.6 mL/min, respectively, p = 0.0134). Neither diabetes mellitus nor hypertension was associated with more rapid deterioration of renal function. CONCLUSION This study suggests that the duration of lithium treatment contribute to the deterioration of renal function, raising the question of reducing dosages in patients with a GFR < 60 mL/min. Overdoses has been identified as a risk factor for CKD, emphasizing the importance of regular re-evaluation of the lithium dose regimen. Also, long-term lithium therapy was associated with hyperparathyroidism and hypercalcemia. Particular vigilance is required on these points in order to limit the occurrence of endocrinological and renal lithium adverse effects.
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Affiliation(s)
- Elise Boivin
- grid.411154.40000 0001 2175 0984Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000 Rennes, France
| | - Brendan Le Daré
- grid.411154.40000 0001 2175 0984Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000 Rennes, France ,grid.410368.80000 0001 2191 9284Institut NuMeCan (Nutrition, Metabolismes et Cancer), Réseau PREVITOX, INSERM, INRAE, Université de Rennes 1, Rennes, France
| | - Romain Bellay
- grid.488406.60000 0000 9139 4930Service Pharmacie, Centre Hospitalier Guillaume Regnier, Rennes, France
| | - Cécile Vigneau
- grid.414271.5Service de Néphrologie, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - Marion Mercerolle
- grid.411154.40000 0001 2175 0984Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000 Rennes, France
| | - Astrid Bacle
- grid.411154.40000 0001 2175 0984Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000 Rennes, France ,grid.410368.80000 0001 2191 9284Univ Rennes, CHU Rennes, INSERM, EHESP, Irset-UMR_S 1085, 35000 Rennes, France
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Rachel M, Galiniak S, Biesiadecki M, Gala-Błądzińska A. Renal Function in Patients with Cystic Fibrosis: A Single-Center Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5454. [PMID: 35564849 PMCID: PMC9105043 DOI: 10.3390/ijerph19095454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023]
Abstract
Cystic fibrosis (CF) is the most common incurable autosomal recessive disease affecting the Caucasian population. As the prognosis for life extension of CF patients improves, co-morbidities, including kidney disease, become more common. Identifying those at the highest risk of kidney injury is therefore extremely important. The aim of this study was to evaluate the biomarkers of renal function in 50 CF patients using the estimated glomerular filtration rate (eGFR) based on creatinine and cystatin C equation as well as serum creatinine (sCr), serum cystatin C (CysC), serum urea and urinary neutrophil gelatinase-associated lipocalin (uNGAL) concentrations. sCr, CysC, urea and uNGAL were estimated. eGFR was calculated according to the CKD-EPI formula. CysC was significantly increased, while eGFR was significantly lower in the CF group than in the controls (p < 0.001 and p < 0.01, respectively). There was no significant difference in the sCr, urea and uNGAL concentrations between patients with CF and healthy subjects. For the purpose of our analysis, in order to assess renal function in patients with CF in clinical practice, the concentration of serum CysC and eGFRCKD-EPI should be determined. Patients with CF presented with renal function impairment pictured by increased serum CysC and decreased eGFR values compared to controls. Unchanged uNGAL concentrations suggested preserved tubular function despite aminoglycoside treatment. Further prospective studies are needed to clarify whether kidney impairment observed in the course of CF progresses.
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Affiliation(s)
- Marta Rachel
- Department of Allergology, Provincial Hospital No. 2, Lwowska 60, 35-301 Rzeszów, Poland
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland; (M.B.); (A.G.-B.)
| | - Sabina Galiniak
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland; (M.B.); (A.G.-B.)
| | - Marek Biesiadecki
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland; (M.B.); (A.G.-B.)
| | - Agnieszka Gala-Błądzińska
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów University, Warzywna 1a, 35-310 Rzeszów, Poland; (M.B.); (A.G.-B.)
- Department of Internal Medicine, Nephrology and Endocrinology, Provincial Hospital No. 2, Lwowska 60, 35-301 Rzeszów, Poland
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Unwin RJ. Toxic nephropathy: Adverse renal effects caused by drugs. Eur J Intern Med 2022; 96:20-25. [PMID: 34607721 DOI: 10.1016/j.ejim.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/29/2021] [Accepted: 09/15/2021] [Indexed: 01/02/2023]
Abstract
This is a brief overview of toxic nephropathy, which is an increasingly recognised problem with the continual introduction of new drugs and novel drug modalities, especially in oncology, and the risks associated with polypharmacy in many patients; although it is important to remember that it may not always be caused by a drug. It is also important to note that several possibly harmful drugs are now available without prescription ('over-the-counter') and can be purchased easily over the internet, including some poorly characterised herbal remedies. Knowing exactly what our patients are taking as medication is not always easy and patients often fail to mention drugs that may not have been prescribed by a doctor or recommended by a pharmacist. Moreover, patients with several comorbidities often require care from more than one doctor in other specialties, which can also lead to drug prescribing in isolation. This article will summarise some key aspects of drug nephrotoxicity and provide a few clinical pointers to consider, bearing in mind that there is rarely any antidote available, and effective treatment relies on early detection, prompt drug withdrawal, and supportive care. This short review is intended only as a primer to highlight some of the more practical aspects of toxic nephropathy; its content is based on a lecture delivered during the 2021 European Congress of Internal Medicine.
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Affiliation(s)
- Robert J Unwin
- Department of Renal Medicine, Royal Free Hospital Trust, University College London, Rowland Hill Street, London NW3 2PF, UK.
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Docosahexaenoic Acid-Acylated Astaxanthin Esters Exhibit Superior Renal Protective Effect to Recombination of Astaxanthin with DHA via Alleviating Oxidative Stress Coupled with Apoptosis in Vancomycin-Treated Mice with Nephrotoxicity. Mar Drugs 2021; 19:md19090499. [PMID: 34564161 PMCID: PMC8467572 DOI: 10.3390/md19090499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 12/30/2022] Open
Abstract
Prevention of acute kidney injury caused by drugs is still a clinical problem to be solved urgently. Astaxanthin (AST) and docosahexaenoic acid (DHA) are important marine-derived active ingredients, and they are reported to exhibit renal protective activity. It is noteworthy that the existing forms of AST in nature are mainly fatty acid-acylated AST monoesters and diesters, as well as unesterified AST, in which DHA is an esterified fatty acid. However, no reports focus on the different bioactivities of unesterified AST, monoesters and diesters, as well as the recombination of DHA and unesterified AST on nephrotoxicity. In the present study, vancomycin-treated mice were used to evaluate the effects of DHA-acylated AST monoesters, DHA-acylated AST diesters, unesterified AST, and the recombination of AST and DHA in alleviating nephrotoxicity by determining serum biochemical index, histopathological changes, and the enzyme activity related to oxidative stress. Results found that the intervention of DHA-acylated AST diesters significantly ameliorated kidney dysfunction by decreasing the levels of urea nitrogen and creatinine, alleviating pathological damage and oxidative stress compared to AST monoester, unesterified AST, and the recombination of AST and DHA. Further studies revealed that dietary DHA-acylated AST esters could inhibit the activation of the caspase cascade and MAPKs signaling pathway, and reduce the levels of pro-inflammatory cytokines. These findings indicated that the administration of DHA-acylated AST esters could alleviate vancomycin-induced nephrotoxicity, which represented a potentially novel candidate or therapeutic adjuvant for alleviating acute kidney injury.
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