Drug-induced renal disease

Drug-induced renal disease is common and responsible for a variety of pathological effects on the kidney, many of which are potentially recoverable. The main types of renal injury predominantly involve the tubules and interstitium, leading to acute tubular injury and necrosis, or interstitial nephritis with inflammatory tubular injury. Aminoglycoside antibiotics, β-lactam antibiotics and non-steroidal anti-inflammatory agents are common offenders. Other types of renal injury are related to vascular damage and more rarely glomerular injury. Thrombotic microangiopathy is one of the most common types of acute vascular injury, whereas more chronic vascular changes leading to ischaemic fibrosis occur with long-term therapy with calcineurin inhibitors and analgesics. A knowledge of the drug history and possible nephrotoxic effects is crucial in renal biopsy interpretation for identifying drug-related renal disease.