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Ass. Lect. Ahmed Abdel Rahman Elsayed Hefnawy :: Publications:

Drug induced glomerular diseases
Authors: Ahmed Abd El Rhman El sayed Hefnawy, El Metwaly Lotfy El Shahawy,Mohammad El Sayed Salem, Ashraf Talat Mahmoud, Mohammad El Tantawy Ibrahim
Year: 2017
Keywords: Not Available
Journal: Not Available
Volume: Not Available
Issue: Not Available
Pages: Not Available
Publisher: Not Available
Local/International: International
Paper Link: Not Available
Full paper Ahmed Abdel Rahman Elsayed Hefnawy_Resala.pdf
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Drugs and toxins are well established causes of renal tubulointerstitial injury, however drug-indued glomerular diseases are also an important concern for clinicians. The glomerular insult associated with drug exposure can be broadly classified into two specific forms: (1) direct cellular toxicity and (2) immune mediated injury. Direct glomerular cell injury, involving the mesangial, endothelial and visceral epithelial cells.  Visceral epithelial cell, drug induced podocytopathy can occur in a number of situations. IFN therapy is associated with podocyte injury that can manifest as nephrotic syndrome and histologic lesions, including MCD or FSGS, of both the collapsing and noncollapsing variety. Pamidronate in high doses cause direct podocyte injury with impaired cell energetics, disrupted cytoskeleton, or altered cell signaling. Chronic lithium exposure can be associated with MCD and less commonly FSGS. NSAIDs may be a cause of MCD which may be because of shunting of AA metabolites into pathways that alter immune function and promote podocye injury. Both sirolimus, and androgenic anabolic steroids frequently abused by bodybuilder can cause FSGS lesion seen on biopsy. 65 summary  Endothelial cell: TMA is a severe form of endothelial injury that occurs systemically and within the renal parenchyma. A drug induced etiology should always be considered including chemotherapeutic agents, IFN, antiplatelet agents, calcineurin inhibitors and quinine.  Mesangial cell injury: Nodular glomerulosclerosis has emerged as a specific lesion associated with cigarettes smoking. Immune mediated injury: Exposure to certain drugs can elicit an immune response that result in generation of autoantibodies and clinical autoimmune disease, including immune complex or pauci immune GN.  ANCA associated vasculitis: Drugs commonly implicated in AAV involve cocaine, levamisole, hydralazine, antithyroid medications, minocycline, allopurinol, penicillamine, and sulfasalazine.  Drug induced lupus: The drugs commonly associated with DIL are hydralazine, procainamide, and anti-TNF therapy.  Membranous nephropathy, which can be induced by gold salts, captopril (the only ACE-I), and NSAIDs. Finally we conclude that, a variety of drugs have the capacity to induce glomerular injury. These drug induced glomerular disease should be part of the differential diagnosis in patients presenting with proteinuria, hematuria, and/or renal insufficiency. Recognition of a drug induced etiology and withdrawal the offending drug providing the best hope of renal recovery.

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