Drug-Induced Kidney Injury: Triggers and Outpatient Management Strategies (Review)

INTRODUCTION. Drug-induced kidney injury (DIKI) is a clinically significant and potentially preventable pharmacotherapy safety issue. Early detection of DIKI in outpatient practice is challenging due to delayed and nonspecific manifestations, while the absence of standardized approaches to monitoring and management increases the risk of adverse clinical outcomes. AIM. Systematization of data on risk factors, drug triggers, pathogenic mechanisms, and options for the diagnosis and management of DIKI in outpatient practice, to facilitate risk stratification, early detection, and the selection of patient management strategies. DISCUSSION. In outpatient practice, key risk factors for DIKI include advanced age, diabetes mellitus, pre-existing chronic kidney disease, dehydration, polypharmacy, uncontrolled use of nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics, and the so-called “triple whammy” combination (angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB) + diuretic + NSAID). Diagnosis is based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria: a rise in serum creatinine of ≥0.3 mg/dL within 48 hours or ≥1.5 times the baseline value within 7 days, or a reduction in urine output to <0.5 mL/kg/h for 6 hours. However, serum creatinine remains a late marker with a diagnostic delay of 24–48 hours, and oliguria may be absent in distal tubule injury. A comprehensive medication history, including over-the-counter drugs and dietary supplements, is essential, with causality assessment using the Naranjo scale. Management of DIKI in outpatient practice involves discontinuation or dose adjustment of the suspected drug, review of concomitant therapy, correction of fluid and electrolyte imbalances, and dynamic monitoring of renal function. Consultation with a clinical pharmacologist is indicated if there is no improvement within 48–72 hours; consultation with a nephrologist is indicated for severe renal dysfunction (estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m², hyperkalemia >6.0 mmol/L), threatening electrolyte disturbances, or the need for a biopsy. CONCLUSIONS. Identification and effective management of patients with DIKI in outpatient practice require clinical vigilance, preventive risk stratification, and dynamic monitoring of renal function. Management is based on timely discontinuation of the nephrotoxic drug, review of therapy, monitoring of the patient’s condition, and patient routing. A promising direction is the integration of novel kidney injury biomarkers (neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and cystatin C) into routine practice for the early detection of subclinical injury.