Prakt. lékáren. 2018; 14(4): 175-178 | DOI: 10.36290/lek.2018.033

Effect of diabetic nephropathy on drug pharmacokinetics

Eliška Dvořáčková¹, Marek Novotný²

¹ Ústavní lékárna IKEM, Praha

² Klinika nefrologie IKEM, Praha

Diabetic kidney disease, formerly referred to as diabetic nephropathy, is a late complication of both basic types of diabetes. It ischaracterized by a complex of morphological and functional changes that are a reflection of systemic metabolic disease. Deviationsfrom normal morphology gradually affect all nephron levels and the renal interstitium. Subsequently, observable functionalchanges occur – the development of albuminuria and proteinuria, reduced glomerular filtration rate, tubular function abnormalities,and potential voiding pathology, including urinary tract infection or neuropathy. The goal of the treatment of diabetic kidneydisease is to reduce cardiovascular and renal morbidity and mortality rates. The treatment is comprehensive and includes lifestylemeasures and potentially extensive pharmacological intervention. Diabetes can, in varying degree, have an impact on the phases ofpharmacokinetics – absorption, distribution, metabolism, and elimination. In terms of absorption, the effects of visceral neuropathyand tissue blood perfusion are considered. Distribution is influenced by body composition. Metabolic abnormalities due to alteredenzymatic activity where the effect of both liver and kidney disease is exerted significantly. The progression of renal insufficiencyin diabetic kidney disease is typically associated with altered drug elimination resulting in a risk of accumulation of not only theparent compound, but also of active metabolites. Awareness of the above-mentioned differences from the general population cancontribute to safe pharmacotherapy in this ever-expanding group of patients.

Keywords: Diabetic kidney disease, drugs, renal elimination

Published: December 15, 2018  Show citation