Phenotype standardization for drug-induced kidney disease

Kidney Int. 2015 Aug;88(2):226-34. doi: 10.1038/ki.2015.115. Epub 2015 Apr 8.

Abstract

Drug-induced kidney disease is a frequent cause of renal dysfunction; however, there are no standards to identify and characterize the spectrum of these disorders. We convened a panel of international, adult and pediatric, nephrologists and pharmacists to develop standardized phenotypes for drug-induced kidney disease as part of the phenotype standardization project initiated by the International Serious Adverse Events Consortium. We propose four phenotypes of drug-induced kidney disease based on clinical presentation: acute kidney injury, glomerular, tubular, and nephrolithiasis, along with the primary and secondary clinical criteria to support the phenotype definition, and a time course based on the KDIGO/AKIN definitions of acute kidney injury, acute kidney disease, and chronic kidney disease. Establishing causality in drug-induced kidney disease is challenging and requires knowledge of the biological plausibility for the specific drug, mechanism of injury, time course, and assessment of competing risk factors. These phenotypes provide a consistent framework for clinicians, investigators, industry, and regulatory agencies to evaluate drug nephrotoxicity across various settings. We believe that this is the first step to recognizing drug-induced kidney disease and developing strategies to prevent and manage this condition.

Publication types

  • Consensus Development Conference
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / pathology
  • Bicarbonates / blood
  • Biopsy
  • Consensus
  • Creatinine / blood
  • Creatinine / urine
  • Delphi Technique
  • Electrolytes / blood
  • Glycosuria / chemically induced
  • Hematuria / chemically induced
  • Humans
  • Kidney Glomerulus / drug effects
  • Kidney Glomerulus / pathology*
  • Kidney Glomerulus / physiopathology
  • Kidney Tubules / drug effects
  • Kidney Tubules / pathology*
  • Kidney Tubules / physiopathology
  • Magnesium / urine
  • Necrosis / chemically induced
  • Nephritis, Interstitial / chemically induced
  • Nephrolithiasis / chemically induced*
  • Phenotype*
  • Phosphates / urine
  • Potassium / urine
  • Proteinuria / chemically induced
  • Time Factors

Substances

  • Bicarbonates
  • Electrolytes
  • Phosphates
  • Creatinine
  • Magnesium
  • Potassium