Several medications--notably acyclovir, sulfonamides, methotrexate, indinavir, and triamterene--are associated with the production of crystals that are insoluble in human urine. Intratubular precipitation of these crystals can lead to acute renal insufficiency. Many patients who require treatment with these medications have additional risk factors, such as true or effective intravascular volume depletion and underlying renal insufficiency, that increase the likelihood of drug-induced intrarenal crystal deposition. Acute renal failure in this setting may be preventable if it is anticipated by appropriate drug dosing, volume expansion with high urinary flow, and alkalinization of the urine when appropriate. Renal failure may be reversible if the drug is discontinued, and by volume repletion and alkalinization of the urine when appropriate. Management of established renal insufficiency includes volume repletion, dialytic support if necessary, adjustment of drug doses, and avoidance of further exposure to nephrotoxins.





Polls results
1

On a scale of 1 to 10, rate how much this article will change your clinical practice?

NO change
BIG change
0% Article relates to my practice (0/0)
0% Article does not relate to my practice (0/0)
0% Undecided (0/0)
2

Will this article lead to more cost-effective healthcare?

0% Yes (0/0)
0% No (0/0)
0% Undecided (0/0)
3

Was this article biased? (commercial or personal)

0% Yes (0/0)
0% No (0/0)
0% Undecided (0/0)
4

What level of evidence do you think this article is?

0% Level 1 (0/0)
0% Level 2 (0/0)
0% Level 3 (0/0)
0% Level 4 (0/0)
0% Level 5 (0/0)