All medicines are toxic. Which medicines are most harmful to the kidneys? And how can we avoid them?

Author: Chen Zhou, attending physician at Shanghai Changhai Hospital, doctor of medicine

Reviewer: Mei Xiaobin, Chief Physician, Shanghai Changhai Hospital

Drugs are a "double-edged sword". Many drugs can treat patients' diseases, but also cause adverse reactions to patients. "All drugs are poisonous", I believe everyone is familiar with this saying, which mainly means that drugs have certain toxic side effects. Indeed, some drugs may harm our liver, some drugs may harm our stomach, and some drugs may harm our kidneys. Today we will talk about which drugs are most harmful to the kidneys.

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There are many reasons why kidneys are vulnerable to drug damage. The human kidney is like a water purifier that never changes its core. It "purifies" our blood all the time, retains the beneficial components in the blood, and filters out the "garbage" of human metabolism (including the drugs themselves and their metabolites) and excretes them in the form of urine. The kidney's 24/7 non-stop working characteristics, which never change the "filter core", make it easy for problems to occur when it comes into "close contact" with certain drugs.

1. Which drugs have clear toxic side effects on the kidneys?

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1. Antibiotics: Antibiotics such as streptomycin, gentamicin, tobramycin, amikacin, rifampicin, and amphotericin B can cause direct or indirect damage to the renal tubules and glomeruli, leading to acute or chronic renal failure.

2. Antipyretic and analgesic drugs: Antipyretic and analgesic drugs such as aspirin, ibuprofen, and acetaminophen can affect renal hemodynamics, reduce glomerular filtration rate, and long-term use may lead to interstitial nephritis.

3. Tumor chemotherapy drugs: Cisplatin, methotrexate, plicamycin, mitomycin-C, nitrosoureas, 5-fluorouracil and other anti-tumor drugs will have direct toxicity to the kidneys and may cause acute kidney injury.

4. Vascular contrast agents: Vascular contrast agents are widely used in imaging examinations, but they may cause damage to the kidneys, which is called contrast-induced acute kidney injury, and it is also the third leading cause of hospital-acquired acute kidney injury. Common vascular contrast agents that may cause kidney damage include iodine contrast agents, high-osmotic contrast agents, etc.

5. Certain Chinese herbal medicines: mainly medicines containing aristolochic acid, such as Aristolochia aristolochia, Aristolochia stephania, Aristolochia mandshurica, Aristolochia scoparia, Aristolochia scabra, Aristolochia chinensis ... etc.

In daily life, antibiotics and antipyretics are commonly used. If you already have kidney disease, you must consult a doctor before taking these two drugs to avoid secondary damage to your kidneys. For other drugs, a specialist doctor is generally required to prescribe them. The doctor will strictly control the indications, contraindications and dosage of the drugs, which is relatively safe. The most important thing to remind everyone is that you should never think that all Chinese herbal medicines have few side effects and high safety. You should find a regular medical institution and a professional Chinese medicine practitioner to prescribe a prescription suitable for your physical condition.

2. 5 common senses that can help you use medicines safely

1. Develop a good habit of reading drug instructions

The drug instructions will record in detail the drug's name, indications, contraindications, usage, drug principles, and possible adverse reactions. Before taking a drug, we should first check the instructions to understand the relevant characteristics of the drug, as the saying goes, "Knowing yourself and your enemy will ensure victory in a hundred battles."

2. Regularly test liver and kidney function before and after taking hepatotoxic and nephrotoxic drugs

For patients taking hepatotoxic and nephrotoxic drugs, liver and kidney function tests are performed before taking the drugs to understand whether they can take the drugs; liver and kidney function tests are performed again 1 to 2 weeks after taking the drugs to determine whether the drugs have caused liver and kidney damage, so as to determine whether they can continue taking the drugs.

3. Don’t take prescription drugs randomly

Prescription drugs must be taken under the guidance of a doctor. Do not take drugs at will according to the advice of relatives and friends. For example, after taking certain drugs, the patient's kidney function may decline. The doctor will ask the patient to stop taking the drugs immediately based on this situation. If we do not take the drugs under the guidance of a doctor, we may continue to take the drugs, causing more serious damage to the kidneys. Of course, over-the-counter drugs are not necessarily absolutely safe. You need to read the drug instructions in detail before using them.

4. Use Chinese herbal medicine with caution

We Chinese generally have the habit of using Chinese herbal medicines, and often think that Chinese herbal medicines are natural plants and will not cause any harm to the body. But in fact, some Chinese herbal medicines are not necessarily safe. For example, the Chinese herbal medicines containing aristolochic acid mentioned earlier have clear nephrotoxicity!

5. Be wary of folk remedies and secret recipes

Many people, when regular medicines are ineffective or they are eager to achieve results, will blindly believe in folk remedies or other drugs of unknown origin. This is an extremely dangerous behavior and irresponsible for their own health. The ingredients of these drugs are unclear and have not been tested by regular national institutions, so they are likely to cause damage to the body.

"All medicines are poisonous", there is a fine line between medicine and poison, and it is safe only if you use medicines carefully and follow the doctor's instructions. Therefore, when faced with medicines of unknown origin and unknown ingredients, you must say NO!

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