Table 1.
Categories of drug-induced acute kidney injury
| Category of kidney injury | Clinical-pathologic diagnosis | Mechanisms of kidney injury | Drug examples |
|---|---|---|---|
| Acute vascular disease | TMA | Direct endothelial injury | Gemcitabine, mitomycin C, calcineurin inhibitors, others |
| VSMC dysfunction (VEGF deficiency) | Anti-angiogenesis drugs | ||
| Antibody mediated | IFN, thienopyridines, quinine | ||
| Vasculitis | Immune-mediated injury | Biologic agents, cocaine adulterated with levamisole, PTU, carbimazole, methimazole, hydralazine, minocycline, allopurinol, febuxostat, penicillamine, sulfasalazine, sofosbuvir in a kidney transplant recipient | |
| Acute glomerular disease | |||
| Epithelial cells (podocytes) | MCD | Direct cellular injury | Pamidronate, IFN, TKIs, lithium, NSAIDs |
| FSGS (including collapsing form) | TKIs, sirolimus, pamidronate, anabolic steroids, lithium, IFN | ||
| Endothelial cells | TMA | (See above) | (See above) |
| ANCA-associated vasculitis | Necrotizing crescentic GN | Immune-mediated injury | (See above) |
| Endocapillar lesions | Class III/IV/V LN | ||
| High risk | TNF-α inhibitors, procainamide, hydralazine | ||
| Moderate risk | Quinidine | ||
| Low risk | TNF-α inhibitors, carbamazepine, PTU, methyldopa, captopril, acebutolol, chlorpromazine, isoniazid, minocycline | ||
| Subepithelial space | Membranous nephropathy | Subepithelial IC deposits | Gold therapy, penicillamine and bucillamine, captopril, NSAIDs |
| Acute tubular disease | Acute tubular necrosis | Direct tubular cell injury | Antineoplastic, antimicrobial, antiviral, antifungal drugs, NSAIDs, calcineurin inhibitors |
| Tubular epithelial vacuolization | Antineoplastic agents, Deferasirox, IVIg | ||
| Intratubular obstruction with or without inflammation | Methotrexate, orlistat, antibiotics, anticoagulants | ||
| Acute interstitial disease | Acute interstitial nephritis | Type 4 hypersensitivity | Antimicrobial agents, PPIs, H2 antagonists, NSAIDs, others |
| Antibody mediated | Immune checkpoint inhibitors |
ANCA, anti-neutrophilic cytoplasmic antibody; FSGS, focal segmental glomerulosclerosis; GN, glomerulonephritis; IFN, interferon; LN, lupus nephritis; MCD, minimal change disease; NSAIDs, nonsteroidal anti-inflammatory drugs; PPIs, proton pump inhibitors; PTU, propylthiouracil; SLE, systemic lupus erythematosus; TKIs, tyrosine kinase inhibitors; TMA, thrombotic microangiopathy; TNF-α, tumor necrosis factor-α; VEGF, vascular endothelial growth factor; VSMC, vascular smooth muscle cell.