8 Drugs That Can Cause Kidney Damage

Your kidneys may be small in size, but they play an important role in the body. Kidneys remove waste, extra fluid, and acids, maintaining a balance of water, salts, and minerals in the blood. They also regulate blood pressure, help make red blood cells, and are involved with keeping your bones healthy.
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Some drugs are known as nephrotoxic, which means that their effects can cause damage to the kidneys.2 Drugs such as certain antibiotics, the mood stabilizer lithium, and nonsteroidal anti-inflammatory drugs (NSAIDs) can potentially harm the kidneys, especially under specific conditions.

1. ACE Inhibitors and ARBs

Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are classes of drugs commonly prescribed for blood pressure and heart conditions. Some information about them is:

• ACE inhibitors end in the letters “pril”; examples include Zestril (lisinopril) and Altace (ramipril).
• ARBs end in the letters “sartan”; examples include Diovan (losartan) and Benicar (olmesartan).

These drugs are actually commonly prescribed to people with kidney disease and other kidney complications.3 While ACE inhibitors and ARBs do not tend to harm the kidneys on their own, certain factors can make kidney injury more likely to occur.

For example, if you are taking one of these medications in combination with an NSAID or with a certain type of “water pill” (diuretic) known as a loop diuretic, or if you are dehydrated, there is an increased risk of acute kidney injury (AKI).

AKI, which used to be known as acute renal failure, happens when the kidneys suddenly lose the ability to remove waste from the blood. It can develop quickly, within days or even hours.

Your healthcare provider will monitor your kidney health while taking an ACE inhibitor or ARB, and you may need extra monitoring if you are taking another medicine that can increase the risk of AKI.

2. Diuretics

Diuretics, are commonly called “water pills” and are prescribed to treat congestive heart failure, high blood pressure (hypertension), and edema (fluid retention).

Diuretics can cause decreased blood flow to the kidneys, affecting their ability to filter blood properly. This can lead to a lack of oxygen and ultimately cause damage to the kidneys.

Researchers have found that loop diuretics such as torsemide or Lasix (furosemide) have a higher risk of causing AKI than thiazide diuretics like hydrochlorothiazide. The risk is higher when taking a diuretic with certain other medications or if you have a medical condition such as high blood pressure, anemia, heart failure, or pneumonia.

If you take a diuretic, your healthcare provider will closely monitor your blood pressure, electrolyte levels, and kidney function.

3. Certain Antibiotics

Antibiotics treat certain types of bacterial infections.

Antibiotics are also one of the most common causes of drug-induced kidney damage. They can harm the tiny filtering units in the kidneys (glomeruli), hurt the kidney tubes that process waste, or clog the tubes with debris, which can prevent them from working properly.

Sometimes, antibiotics can trigger an allergic reaction that causes inflammation in the kidneys, known as acute interstitial nephritis (AIN).

Examples of antibiotics that are associated with kidney injury include:9

• Aminoglycoside antibiotics, such as gentamicin
• Bactrim (trimethoprim/sulfamethoxazole)
• Beta lactams, such as penicillin
• Fluoroquinolones, such as Cipro (ciprofloxacin) or Levaquin (levofloxacin)
• Tetracyclines, such as doxycycline or Minocin (minocycline)
• Vancocin (vancomycin)

4. Proton Pump Inhibitors (PPIs)

PPIs are a class of drugs commonly sold over the counter (OTC) or in higher, prescription strengths to manage certain gastrointestinal conditions, such as heartburn or ulcers. Two examples of PPIs are Nexium (esomeprazole) and Prilosec (omeprazole).10

While they may be effective for certain conditions, they also come with risks to the kidneys, including AKI, AIN, and chronic kidney disease.

Healthcare providers will weigh the risks vs. benefits of prescribing or recommending a PPI, especially if you already have kidney problems or are at risk of developing one. People who take PPIs will have their kidney function closely monitored.

5. Nonsteroidal Anti-Inflammatory Drugs

NSAIDs are both prescription and OTC drugs that help treat fever, pain, and inflammation (swelling). They include:

• Advil or Motrin (ibuprofen)
• Aleve (naproxen)
• Aspirin
• Mobic (meloxicam)

NSAIDs are associated with various kidney problems, including AKI and chronic kidney disease. Taking them every day may increase the risk of developing chronic kidney disease. Also, taking NSAIDs in combination with certain other drugs, such as diuretics and/or ACE inhibitors or ARBs, can further increase the risk of kidney problems.

If you regularly take NSAIDs, especially along with other medications, talk to your healthcare provider about safer alternatives and ways to monitor your kidney function.

6. Lithium

Lithium is a drug commonly prescribed for certain mental health conditions, including bipolar disorder. It can cause problems with the kidneys, including acute or chronic kidney disease, as well as kidney cysts.

Lithium can also cause a condition called nephrogenic diabetes insipidus. This is not the same type of diabetes that causes high blood sugar; rather, it is diabetes caused by kidney damage, in which the kidneys cannot properly respond to certain hormones needed to control fluid balance. This leads to excessive thirst and urination.14

If you take lithium, your healthcare provider will monitor your lithium levels closely and monitor your kidney function regularly.

7. Certain Human Immunodeficiency Virus (HIV) Medications

Certain HIV medications are associated with kidney damage. For example, Viread (tenofovir disoproxil fumarate, or TDF) is a nucleotide reverse transcriptase inhibitor (NRTI) associated with nephrotoxicity. Other HIV drugs, such as efavirenz, indinavir, and atazanavir, are also associated with kidney problems.15

However, the HIV drug Vemlidy (tenofovir alafenamide, or TAF) is processed differently in the body and is considered safer for the kidneys. For people at increased risk for kidney problems, healthcare providers may consider the tenofovir alafenamide form (available as a single drug or as an ingredient in several combination drugs) over other HIV medications.15

8. Calcineurin Inhibitors

Calcineurin inhibitors are commonly used after an organ transplant to prevent the immune system from attacking the transplanted organ. Examples of calcineurin inhibitors include cyclosporine and Prograf (tacrolimus).

While these medications are important for preventing organ rejection, even a small overdose can lead to serious side effects, including kidney failure. Calcineurin inhibitors can damage the kidneys by causing blood vessels in the kidneys to tighten, reducing blood flow and oxygen. This leads to long-term damage, including scarring and shrinking of kidney tissue.16

Studies show that most kidney transplant patients will experience signs of kidney damage from these medications within 10 years of their transplant. If you take a calcineurin inhibitor, your healthcare provider will closely monitor you for potential side effects, including kidney problems.16

How Drugs Can Cause Kidney Damage

Most drugs that can harm the kidneys do so in a few common ways. For example, they may:

• Change how blood flows through the kidneys
• Directly damage kidney cells
• Cause inflammation
• Block the kidney’s filters with crystals
• Break down muscle tissue (which then clogs the kidneys)
• Lead to tiny blood clots that affect kidney function17

Additionally, certain drugs can be more likely to cause kidney problems under certain conditions. While the risk factors vary by drug, some common ones that could increase the risk for kidney problems include:

• Dehydration
• Dose or duration of treatment
• Electrolyte imbalances
• Diabetes
• Older age
• Previous kidney problems18

Protecting Your Kidneys From Medication Damage

You should always ensure that your healthcare provider knows about all of your medical conditions, your medical and family histories, the allergies you have, and the medications you take. Tell your provider about all the medications you take, including prescription and OTC drugs, vitamins, and supplements.

Do not start any new medicine before checking with your healthcare provider. Even drugs that are available without a prescriptions can harm the kidneys.

You can help protect your kidneys against drug-induced damage by doing the following:19

• Fill all of your prescriptions at one pharmacy or within one chain so the pharmacist can see all of the medications you take and monitor for potential problems.
• Keep an up-to-date list of your medications and bring it to all your appointments.
• Dehydration can increase the risk of kidney problems, so talk to your healthcare provider about what to do if you have symptoms of an illness that can lead to dehydration, such as a fever, vomiting, or diarrhea. They can advise you on which medications to avoid and how much fluid to drink.

When to Contact a Healthcare Provider

Sometimes, kidney problems do not produce any symptoms. For this reason, it’s crucial to keep all appointments with your healthcare provider for follow-up and monitoring.

The following symptoms can be signs of serious kidney complications:620

• Back or flank pain (pain on the side, below the ribs)
• Blood in the urine
• Chest pain
• Confusion
• Fatigue and tiredness
• Fever or chills
• Low appetite
• Nausea
• Swelling in the lower legs and/or feet
• Trouble breathing, such as shortness of breath
• Urinary problems, such as pain during urination, difficulty urinating, urinating less or not at all, or feeling a constant urge to urinate
• Urine that is not the usual color

Summary

The kidneys have many important functions to keep the body working properly. Certain drugs are nephrotoxic, which means they can cause harm to your kidneys. There are many medications that can harm the kidneys. Some of these are ACE inhibitors and ARBs, diuretics, antibiotics, PPIs, NSAIDs, lithium, HIV drugs, and calcineurin inhibitors.

Always consult a healthcare provider for information and medical advice about your kidney health and the medications—both prescription and OTC—vitamins, and supplements you take.