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medication-induced acute kidney injury
Etiology:
- fluid loss from a febrile illness, in combination with an ACE inhibitor, a diuretic, & an NSAID (triple whammy) may result in acute kidney injury [1]
Clinical manifestations:
- uremia may result in fatigue, anorexia, & confusion Labatoratory:
- increased serum creatinine & eGFR
- increased serum urea nitrogen (uremia)
- urinalysis: granular casts
Differential diagnosis:
- acute interstitial nephritis
- mean time from beginning NSAID to initial signs of renal failire is 10 days
- may be faster if patient has taken the NSAID previously
- fever, rash, eosinophilia, pyuria, & WBC casts may be seen
Related
triple whammy
General
acute renal failure (ARF)
References
- NEJM Knowledge+ Question of the Week, Jan 28, 2020
https://knowledgeplus.nejm.org/question-of-week/1155/answer/
- Prescriber's Letter 13(12): 2006
The Triple Whammy
Detail-Document#: 221202
(subscription needed) http://www.prescribersletter.com
- Lapi F et al
Concurrent use of diuretics, angiotensin converting enzyme
inhibitors, and angiotensin receptor blockers with non-steroidal
anti-inflammatory drugs and risk of acute kidney injury:
nested case-control study.
BMJ 2013;346:e8525
PMID: 23299844
http://www.bmj.com/content/346/bmj.e8525