Since renal function is so diverse, it is impossible to give a unique definition of a renal adverse reaction.
DEFINITIONS AND DIAGNOSIS
Since
renal function is so diverse, it is impossible to give a unique definition of a
renal adverse reaction. The physiological role of the kidney and the clini-cal
manifestation of malfunction are summarised in Table 38.1).
Drug-induced
decrease in renal function is a major side effect in clinical practice. ARF is
defined as an acute onset of severe deterioration of renal function
necessitating renal replacement therapy. In the context of clinical studies,
nephrotoxicity is more readily defined as a predefined level of decrease of
renal func-tion. In chronic renal failure (CRF) deterioration of renal function
proceeds more progressively. A clini-cal manifestation of drug-induced renal
failure, that is particularly frequent, is the so-called acute-on-chronic renal
failure. In this setting acute drug-induced injury is superimposed on
chronically damaged renal tissue.
The
absence of an effect on filtration function does not preclude a renal adverse
effect. For exam-ple, due to renal salt wasting, polyuria and ortho-static
hypotension may be the first manifestation of an adverse reaction of the
tubulotoxin cisplatin (Hutchison et al.,
1988).
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