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Renal Week Program looks at
new medical causes of Kidney
Disorder
Newswise — Nephrologists and other health care providers need
to be aware of certain medications and
diagnostic test preparations that, in some
patients, can cause damage to the kidneys,
according to a special clinical update being
presented at the American Society of
Nephrology's 40th Annual Meeting and
Scientific Exposition in San Francisco.
The four presentations in this special Clinical Nephrology
Conference (CNC) draw attention to several
recently recognized "iatrogenic" (caused by
medical treatments or tests) kidney
disorders. Some of the problems are related
to widely used products, including
bisphosphonate drugs used to treat
osteoporosis and "bowel prep" solution used
to prepare for colonoscopy.
Dr. Daniel W. Coyne of Washington University School of
Medicine, St. Louis, Mo., discusses the risk
of kidney disorders associated with the use
of bisphosphonates. Increasing evidence
suggests that, in some circumstances, these
widely used osteoporosis drugs can cause
certain types of kidney damage. The risks
are higher with "nitrogen-containing" types
of bisphosphonate drugs and may depend on
the individual patient and the total dose
over time. Fortunately, the kidney damage is
usually reversible after bisphosphonate
treatment has stopped.
Despite these risks, bisphosphonates remain important in
treating the high rate of osteoporosis in
patients with kidney disease. Recent studies
have even suggested that bisphosphonates can
slow the buildup of calcium deposits in the
blood vessels of patients on dialysis.
Dr. Glen S. Markowitz of Columbia University provides an
update on the risks of acute and chronic
renal failure related to the use of oral
sodium phosphate solution. This product is
widely used to prepare the bowels before
procedures such as colonoscopy or surgery.
There is special concern about a rare but serious type of
renal failure called acute phosphate
nephropathy. Last year, the U.S. Food and
Drug Administration issued an alert about
this complication, including advice to avoid
oral sodium phosphate solution in patients
with kidney disease. Dr. Markowitz believes
that the FDA warning, together with careful
selection of the most appropriate "bowel
prep" for individual patients, will reduce
the number of patients with this condition.
Dr. Roger A. Rodby of Rush University Medical Center,
Chicago, Ill., compares the risk of kidney
injury caused by contrast agents containing
iodine (used for computed tomography [CT]
scanning as well as other imaging tests) to
that associated with the use of gadolinium
(used for magnetic resonance imaging [MRI]).
The toxic effects of iodine on the kidneys
have long been recognized. More recently, it
has been found that newer gadolinium-based
contrast agents may also cause kidney
damage.
However, at typical doses, gadolinium-based contrast appears
less toxic to the kidneys than iodine-based
contrast. All reported cases of acute kidney
failure linked to gadolinium have occurred
in patients who already had advanced kidney
disease. While the risk may be real, Dr.
Rodby reminds physicians that patients with
advanced kidney disease should probably not
receive gadolinium anyway because of the
association of exposure to gadolinium and
the risk of another recently recognized
complication, called nephrogenic systemic
fibrosis.
Dr. Charles E. Alpers of University of Washington, Seattle,
provides an update on drug-induced
thrombotic microangiopathy (TMA)—a group of
conditions in which clots form in the small
blood vessels, causing damage to the kidney
or other organs. Several different types of
medications, including certain chemotherapy
and immunosuppressive drugs, have been
linked to TMA.
Immune-suppressing drugs called calcineurin inhibitors, which
are very important in preventing rejection
after organ transplantation, can cause a
type of TMA leading to acute kidney failure.
Fortunately, outcomes are better than with
most other forms of TMA—kidney function
generally returns after calcineurin
inhibitor treatment is stopped. Dr. Alpers
calls for more research to clarify how
drug-induced TMA occurs, and to develop new
treatment options.
"These presentations will help provide nephrologists with the
most up-to-date information on iatrogenic
renal disorders, helping them to play a key
role in assessing patient risk for these
disorders, recognizing them when they occur,
and recommending the most appropriate
treatment," states Kevin C. Abbott, MD,
moderator of the program. Vivette D. D'Agati,
MD will co-moderate this exciting program.
The program, "Newer Iatrogenic Renal Disorders," will be
presented on Sunday, November 4, 2007 from
10:00 AM to 12:00 PM in Room 103 of the
Moscone Center in San Francisco.
The ASN is a not-for-profit organization of 10,500 physicians
and scientists dedicated to the study of
nephrology and committed to providing a
forum for the promulgation of information
regarding the latest research and clinical
findings on kidney diseases. ASN’s Renal
Week 2007, the largest nephrology meeting of
its kind, will provide a forum for 11,000
nephrologists, to discuss the latest
findings in renal research and engage in
educational sessions relating advances in
the care of patients with kidney and related
disorders from October 31 – November 5 at
the Moscone Center in San Francisco, CA.
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