All medicines are poisonous. Which medicines are most harmful to the kidneys?

Author: Chen Zhou, attending physician at Shanghai Changhai Hospital

Reviewer: Mei Xiaobin, Chief Physician, Shanghai Changhai Hospital

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The kidney is an important organ in the human body. Its main function is to filter waste and excess water from the blood and form urine to be excreted from the body. The kidney is also involved in regulating blood pressure, electrolyte and acid-base balance, red blood cell production and other physiological processes. There are many reasons why the kidney is easily damaged by drugs.

The two kidneys in the human body are like an automatic filtration factory that never stops, filtering the "garbage" of human metabolism (including drugs themselves and their metabolites) from the blood at all times and excreting them out of the body in the form of urine. The 24/7 working nature of the kidneys makes it easy for them to have problems after "close contact" with drugs.

So, which drugs are most harmful to the kidneys? Here are some common examples for your reference:

1. Antibiotics : This type of medicine is often used in our daily life. For example, in cases of colds, fever, pharyngitis, urinary tract infections, etc., doctors may prescribe some antibiotics for us. However, not all antibiotics are harmless to the kidneys. Some antibiotics can cause serious consequences such as tubular necrosis, interstitial nephritis, and acute kidney injury, such as aminoglycoside antibiotics such as streptomycin, gentamicin, tobramycin, and amikacin, as well as other types of antibiotics such as rifampicin, vancomycin, and amphotericin B. When using these drugs, you must follow the doctor's advice, check renal function indicators on time, and avoid excessive or prolonged use.

2. Antipyretic analgesics : This type of medicine is also our common home medicine. For example, in cases of headache, joint pain, toothache, etc., we may take some antipyretic analgesics to relieve symptoms. However, not all antipyretic analgesics are harmless to the kidneys. Some antipyretic analgesics can cause serious consequences such as glomerulosclerosis, interstitial nephritis, and acute kidney injury. Common antipyretic analgesics include non-steroidal anti-inflammatory drugs (NSAIDs) such as indomethacin, ibuprofen, phenylbutazone, and naproxen, as well as other types of antipyretic analgesics such as acetaminophen (paracetamol) and analgin. When using these drugs, be sure to control the dosage and frequency, and do not take them for a long time or in excess.

3. Tumor chemotherapy drugs : These drugs are used to treat cancer. They kill cancer cells, but they can also damage normal cells, including kidney cells. The chemotherapy drugs that can cause kidney damage mainly include cisplatin, methotrexate, plicamycin, mitomycin C, nitrosoureas, 5-fluorouracil, etc. When using these drugs, you must be under the guidance of a professional doctor and check your kidney function indicators on time to avoid unnecessary complications.

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4. Anti-epileptic drugs : Some anti-epileptic drugs, such as trimethoprim-sulfamethoxazole and phenytoin sodium, can cause serious consequences such as water intoxication, hyponatremia, and interstitial nephritis. When using these drugs, you must follow the doctor's advice and check blood and urine indicators regularly.

5. Vascular contrast agents : These drugs are used for imaging examinations, such as enhanced CT and magnetic resonance imaging (MRI). Their function is to enhance the contrast of blood vessels, allowing doctors to see the situation inside the blood vessels more clearly. However, not all vascular contrast agents are harmless to the kidneys. Some vascular contrast agents can cause acute kidney injury. For example, iodinated contrast agents and gadolinium contrast agents. When using these drugs, they must be under the supervision of a professional doctor, and the risk of renal function must be assessed in advance and preventive treatment must be given.

6. Chinese herbal medicine : This type of medicine is part of our traditional medicine. They come from plants, animals and minerals in nature. Some of them have good therapeutic effects, but they are not without side effects. Some Chinese herbal medicines can cause serious consequences such as glomerular damage, interstitial nephritis, acute and chronic renal failure. The more famous ones are plant-based Chinese medicines containing aristolochic acid, such as Aristolochia guanidii, Aristolochia fangji, Aristolochia mandshurica, Tianxianteng, etc.; there are also animal-based Chinese medicines such as blister beetles, fish gall, seahorse, centipede, snake venom; there are also mineral-based Chinese medicines such as arsenic, arsenic trioxide, realgar, cinnabar, red lead, and alum. When using these medicines, you must find a regular Chinese medicine practitioner to prescribe them and use them dialectically and rationally. Don't be too superstitious or take them casually.

The above are some common kidney-damaging drugs that I introduced to you. Of course, there are many other drugs that may also cause varying degrees of damage to the kidneys, which I will not list here one by one. I want to convey a message to everyone through this article: All drugs are toxic , and any drug may have adverse effects on the kidneys, so we must be cautious when using drugs, do not take them casually, and do not abuse or overdose. We should follow the following principles:

1. Follow the doctor's advice : Do not buy medicine on your own or use other people's medicine. Take medicine according to the doctor's instructions, including dosage, frequency, time, method, etc. Do not increase or decrease or stop taking medicine at will.

2. Check renal function : Before and after taking the medicine, you should regularly check renal function indicators, such as blood creatinine, urea nitrogen, urine protein, etc., to detect abnormal changes in the kidneys in time and adjust the medication plan in time.

3. Drink plenty of water : During the medication period, drink plenty of water to maintain adequate urine volume to promote the excretion of drugs and metabolites and reduce accumulation in the kidneys and damage to the kidneys.

4. Pay attention to diet : During the medication period, pay attention to a healthy and balanced diet, avoid excessive intake of salt, protein, sugar, etc., and reduce the burden and pressure on the kidneys.

5. Consult an expert : If you have any questions or discomfort about medication, consult a professional doctor or pharmacist in time. Do not act on your own or believe in rumors.