SOUTO, Isabel Cristina da Silva.
Resumo:
As a result of the physiological process of aging, the elderly are more affected by drug
interactions, toxicity events and adverse drug effects. Associated comorbidities favor the
occurrence of polypharmacy, considered a risk factor for nephrotoxicity. Therefore, the
general objective of this work was to describe the main nephrotoxic drugs used by the elderly
and their effects that induce acute kidney injury. This is an integrative review of the literature
that aims to gather and synthesize knowledge on a defined topic, assisting in decision-making
and improvements in clinical practice. The search for studies consistent with the theme took
place in electronic databases: Virtual Health Library (VHL), Portal Periódicos Capes,
ScienceDirect and Pubmed/Medline, between the years 2013 and 2023. Search strategies were
used that resulted in the identification of 293 studies and after evaluation according to the
inclusion and exclusion criteria, 10 studies were selected. This work showed that the main
nephrotoxic drugs used by the elderly were: antibiotics from the classes of aminoglycosides
(gentamicin), glycopeptides (vancomycin) and sulfonamides
(sulfamethoxazole-trimethoprim), antihypertensives (angiotensin-converting enzyme
inhibitors and receptor blockers angiotensin II), the loop diuretic furosemide, the antifungal
amphotericin B, non-steroidal anti-inflammatory drugs, antineoplastics (cisplatin and
methotrexate) and radiological contrast media. The main effects inducing acute kidney injury
consisted of hemodynamic changes (systemic and glomerular), decreased pressure, low
glomerular filtration, ischemic events, oxidative damage, cell apoptosis, tissue necrosis and
physical tubular lesions caused by crystals. Therefore, the pharmaceutical professional
inserted in the community and in the hospital, by offering clinical services such as
pharmacotherapeutic monitoring, medication reconciliation, therapeutic monitoring and
medication dispensing, plays an important role in preventing the occurrence of acute kidney
injury in elderly people due to the use of nephrotoxic drugs, promoting a reduction in the
occurrence of adverse reactions and dangerous drug interactions for this population.