Nephrotoxicity (Kidney Drug Toxicity)

What are the signs and symptoms of nephrotoxicity?

Mild nephrotoxicity can go undetected because decreased kidney function does not always cause obvious signs or symptoms. If severe enough, nephrotoxicity can show signs of other types of decreased kidney function, such as decreased urination, swelling from fluid retention and high blood pressure. In some patients, nephrotoxicity can also affect other body systems such as the liver or the skin and show signs in those areas as well.

What tests are used to diagnose nephrotoxicity?

Blood and urine test results will show if kidney function is being affected by nephrotoxicity. Laboratory testing is usually required to identify the level of nephrotoxicity. Kidney imaging, commonly by ultrasound, can also be helpful. A kidney biopsy is occasionally needed to confirm a diagnosis and assess the type and degree of kidney damage. A biopsy may also help your child’s doctor decide on the most effective treatment

What to expect from a kidney biopsy

At Children’s Hospital Colorado, we perform a kidney biopsy as an outpatient procedure. We either use sedation to calm your child, or we use full anesthesia, which puts them completely to sleep to eliminate stress and pain as much as possible. To get the tissue sample, we insert a needle through the back onto the surface of the kidney. Using real-time ultrasound to help us guide the needle, we remove a very small piece of kidney tissue. We then examine the tissue under a microscope in collaboration with our pediatric pathology team.

After the procedure, which usually lasts about one hour, we will wake your child and monitor them to ensure they are stable to return home. If there are no complications, they may leave the hospital. We recommend your child avoids strenuous activities for 7 to 10 days. Once the biopsy results are available in a few days, we discuss them with you and your child and work with you to develop the best treatment plan.

How is nephrotoxicity treated?

Nephrotoxicity treatment depends on its apparent cause and severity. Milder cases may only require removal of the suspected chemical or medication causing the problem. In some cases, nephrotoxic drugs may need to be continued if they are essential for a patient’s successful care, even though they may be harming the kidney (chemotherapy, for example).

If there is a lot of kidney inflammation that is attributed to nephrotoxicity, which we could tell from a biopsy, we might suggest a course of steroid treatment to reduce the inflammation. If either acute kidney injury (AKI) or chronic kidney disease (CKD) due to nephrotoxicity are severe enough, we may suggest kidney dialysis to substitute kidney function. If irreversible, advanced CKD has developed, we may discuss kidney transplantation and make a referral for an evaluation.

Why choose us for treatment of nephrotoxicity?

Nephrotoxicity can require a broad range of highly specialized multidisciplinary care. For children, this range of care is available at Children’s Colorado, with its pediatric Kidney Care team and all the other pediatric services that may need to be involved, such as our pediatric Department of Pharmacy.

Depending on the type and severity of the nephrotoxicity, we may need to conduct thorough assessments through different departments to identify what medication may be responsible for a child’s nephrotoxicity and whether this medication can be stopped. If your child does require dialysis or kidney transplantation, we are well-equipped to handle both. Children’s Colorado offers the only child-specific dialysis and transplant programs in the region, with outstanding outcomes compared to the national average.

Helpful resources

The National Kidney Foundation focuses on scientific research and innovation on a variety of kidney diseases. This page talks about chronic kidney disease, which is often related to nephrotoxicity.