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Clinical practice guideline for drug-induced kidney injury in Japan 2016: digest version

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Abstract

Approximately one in eight adults has chronic kidney disease (CKD) in Japan, and the prevalence rate is expected to rise steeply due to the aging of the population in this country. In patients with CKD, quite a few medications require the dosage reduction or discontinuation because of their reduced urinary excretion and the increased risk of further renal impairment. Therefore, CKD patients are often treated by insufficient amounts of the medications, even though they may suffer from various complications. Moreover, it is empirically known that drug-induced kidney injury (DKI) accelerates the progression of renal failure, while it is not superficially ranked as a primary cause of kidney disease. In this context, the early detection, prevention, and treatment of DKI are very important issue in preventing the progression of CKD and the development of renal failure. However, there are no comprehensive and practical guideline on the diagnosis and treatment of DKI for CKD patients and on dosage adjustments for these patients. In response to this need, a clinical practice guideline for DKI was developed with the support of a Health and Labour Science Research Grant from the Ministry of Health, Labour, and Welfare (MHLW) and the Japan Agency for Medical Research and Development (AMED) for Practical Research Project for Renal Diseases, “Early detection and treatment of drug-induced kidney injury that aggravate chronic kidney disease.” This guideline was established by doing a clinical survey on DKIs, evaluating clinicopathological factors, investigating the methods of the early detection of the disease, and analyzing animal models. The present article represents a Committee of Clinical Practice Guideline for DKI. We collected supportive evidence and analyzed data, focusing on several clinical questions that have practical importance.

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