Medication-Induced Kidney Injury for the Primary Care Pediatrician

Purpose of reviewMedication-induced kidney injury is one of the most common causes of acute kidney injury (AKI); however, it is often under-recognized. The purpose of this review is to aid providers to recognize patterns of kidney injury induced by specific nephrotoxic agents that are used in ambulatory care and the identification of children at high risk of these complications.Recent findingsAcute kidney injury prevention by nephrotoxic medication avoidance has been advanced greatly by the NINJA (Nephrotoxin Injury Negated by Just in Time Action) project. This work in the inpatient setting has led to a better understanding of the true incidence of nephrotoxicity-associated AKI as well as the ability to avoid this complication. While this work was performed in the inpatient setting, the knowledge gained has helped to shed light on the potential improvements in outcomes with more thoughtful prescribing.Additionally, ongoing work on sub-phenotype patterns of nephrotoxic kidney injury has enhanced diagnostic capabilities and thus led to an earlier withdrawal of offending agents. An understanding of the common biologic mechanisms by which medications cause injury, and thus the expected clinical phenotypes, has helped providers detect and manage AKI associated with nephrotoxic agents.SummaryAKI is a common clinical problem with a wide range of potentially serious sequelae. Nephrotoxic medication exposure is one of the leading contributors to acute kidney injury in children, particularly when combined with additional risk factors. AKI is not an inevitable complication of medical illness and therapy and, in the right clinical context, can be avoided.