[Pharmacologic insult as a cause of acute kidney failure with a need for acute hemodialysis therapy]. / Farmakologický inzult jako prícina "akutního" selhání ledvin s nutností akutní hemodialyzacní lécby.

ABSTRACT

Acute renal failure is a heterogeneous disease. In advanced countries the incidence of acute renal failure is rising steadily in the elderly population. One of the serious causes of renal failure in this age group are pharmacological preparations and iodine radiocontrast diagnostic substances. It was revealed that also commonly used drugs may have a nephrotoxic potency in subjects with pre-existing renal disease and/or in certain clinical risk situations. In a group of 133 acutely haermodialyzed patients at the medical department we made a detailed clinical and economic analysis of treatment in a group of patients haemodialyzed on account of acute drug induced renal failure. These patients accounted for 28% of all acutely haemodialyzed patients and 65% of them were older than 65 years. The drugs which were involved as the cause or partial cause of renal failure had a negative effect on intrarenal haemodynamics. They comprised in the first place inhibitors of the angiotensin converting enzyme and non-steroid antirheumatic drugs, frequently in combination with diuretics or an iodine contrast substance. A risk factor was preexisting nephropathy defined by the presence of renal perfusion depending on increased formation of angiotensin II and renal vasodialatating prostaglandins. Risk is ascribed also to pathological conditions associated with systemic hypotension and a reduced effective circulating volume. Costs of treatment per patient with drug induced renal failure were calculated as 127,000 Czech crowns. The sum was calculated as the cost of the diagnosis related group.