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September 1991

latrogenic Renal Disease

Author Affiliations

From the Nephrology Division, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minn (Drs Davidman, Olson, Kohen, and Leither); and the Nephrology Division, Department of Medicine, University of Alberta Hospital, Edmonton (Dr Kjellstrand).

Arch Intern Med. 1991;151(9):1809-1812. doi:10.1001/archinte.1991.00400090095017

We studied iatrogenic problems in nephrology by classifying all patients for nephrology consultation into nine presenting syndromes and seven etiologic groups. One hundred (2.2%) of all admissions were seen in nephrology consultation. Acute renal failure was the most common presenting syndrome, accounting for 59% of the consultations. Fortyone of the 100 consultations (1% of all admissions) had a renewal syndrome of iatrogenic origin. Of these 41 patients, 38 had acute renal failure and three had fluid and electrolyte problems. Twenty of the 41 patients had drug-induced problems. Eighteen of these patients were dehydrated, and in three patients, acute renal failure occurred after surgery. Of the 20 patients with iatrogenic renal problems caused by drugs, seven problems were antibiotic related, five were due to diuretics, four were due to nonsteroidal antiinflammatory drugs, three were due to angiotensinconverting enzyme inhibitors, and one was from the use of contrast medium. The 41 patients with iatrogenic-related renal disease were older than the other 59 patients (61.8 vs 49.3 years). latrogenic renal disease developed in 1% of all patients admitted to a tertiary care hospital, and 12% of these patients died. The most common renal syndrome is acute renal failure, most often caused by nephrotoxic drugs. The incidence can probably be decreased by better monitoring of body weight and fluid balance to prevent dehydration and by the avoidance of nephrotoxic drugs.

(Arch Intern Med. 1991;151:1809-1812)