Medications	Risk factors	Prevention strategies
Drugs altering intraglomerular hemodynamics10–12,23,32
ACE inhibitors, ARBs, NSAIDs	Underlying renal insufficiency; intravascular volume depletion; age older than 60 years; concomitant use of ACE inhibitors, ARBs, NSAIDs, cyclosporine (Neoral), or tacrolimus (Prograf)	Use analgesics with less prostaglandin activity (acetaminophen, aspirin, sulindac [Clinoril], nabumetone [Relafen; brand not available in the United States])
		Correct volume depletion before initiation of drug, especially if used on a chronic basis
		Monitor renal function and vital signs following initiation or dose escalation, especially if used in at-risk patients
Cyclosporine, tacrolimus	As above, plus: excessive dose, concomitant use with other nephrotoxic drugs or drugs that inhibit cyclosporine or tacrolimus metabolism	Monitor serum drug concentrations and renal function
		Use lowest effective dose
Drugs associated with tubular cell toxicity7,12,13,37,38
Aminoglycosides	Underlying renal insufficiency, duration of therapy > 10 days, trough concentrations > 2 mcg per mL, concomitant liver disease, hypoalbuminemia	Use extended-interval dosing
		Administer during active period of day
		Limit duration of therapy
		Monitor serum drug levels and renal function two to three times per week
		Maintain trough levels ≤ 1 mcg per mL
Amphotericin B (Fungizone; brand not available in the United States)	Underlying renal insufficiency, rapid infusion, large daily dosage, deoxycholate formulations more so than lipid formulations, prolonged duration of therapy	Saline hydration before and after dose administration
		Consider administering as a continuous infusion over 24 hours
		Use liposomal formulation
		Limit duration of therapy
Contrast dye	Underlying renal insufficiency, age older than 70 years, diabetes, heart failure, volume depletion, repeated exposures	Use low-osmolar contrast in the lowest dose possible and avoid multiple procedures in 24 to 48 hours
		0.9% saline or sodium bicarbonate (154 mEq per L) infusion before and after procedure
		Withhold NSAIDs and diuretics at least 24 hours before and after procedure
		Monitor renal function 24 to 48 hours postprocedure
		Consider acetylcysteine preprocedure
Drugs associated with chronic interstitial nephropathy11,20–23
Acetaminophen, aspirin, NSAIDs	History of chronic pain, age older than 60 years, female sex, cumulative consumption of analgesic > 1 gram per day for more than two years	Avoid long-term use, particularly of more than one analgesic
		Use alternate agents in patients with chronic pain
Lithium	Elevated drug levels	Maintain drug levels within the therapeutic range
		Avoid volume depletion
Drugs associated with crystal nephropathy12,13,24
Acyclovir (Zovirax), methotrexate, sulfa antibiotics, triamterene (Dyrenium)	Volume depletion, underlying renal insufficiency, excessive dose, intravenous administration	Discontinue or reduce dose
		Ensure adequate hydration
		Establish high urine flow
		Administer orally