5 common medicines that can damage kidneys and what are the alternatives

Kidneys quietly do a lot of heavy lifting, they filter waste, balance fluids, control blood pressure, and more. But sometimes, medicines meant to help us can backfire and harm these vital organs. In India, the burden of chronic kidney disease (CKD) is growing fast: according to a recent study published in The Lancet, about 138 million Indians are estimated to have CKD in 2023. Between 2018 and 2023, the prevalence among adults rose to approximately 16.4 %, up from about 11.2% a few years ago, as per a study published in the NIH.

This is important, not just because kidney disease is common, but because for many people, it’s silent until things go badly wrong. Part of the problem is drug-induced damage. Certain medications can stress or injure the kidneys, especially if used long-term or without careful monitoring.Here are six types of medicines that are known to potentially harm kidneys, how they do it, and what to watch out for.

Painkillers like ibuprofen, naproxen, diclofenac, and other NSAIDs are widely used. While they ease pain, they also block the production of prostaglandins, molecules that help dilate blood vessels in the kidney, according to a study from NIH. Without enough prostaglandins, kidney blood flow can drop, especially when someone is dehydrated or has low blood volume, leading to acute kidney injury. Long-term use can trigger chronic damage: NSAIDs may cause interstitial nephritis (inflammation in the kidney), papillary necrosis, or even gradual decline in kidney function. A pharmacovigilance study in India even linked extended NSAID use with chronic kidney disease.Dr Umesh Gupta, Director Nephrology, Aakash Healthcare, said, “Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), while useful for pain relief can damage the kidneys by reducing blood flow to the kidneys when taken regularly and in high doses. It is best to use them only when needed and at the lowest effective dose for the shortest time possible.”Risk factors: older age, dehydration, existing kidney disease, heart failure, or using other drugs that affect kidney perfusion.Tip: Use the lowest effective dose, for the shortest duration possible, and talk to a doctor if you need NSAIDs frequently.

Aminoglycosides are a class of antibiotics (like gentamicin, tobramycin, amikacin) used for serious bacterial infections. These drugs accumulate in the proximal tubule cells of the kidney. Over time, they generate reactive oxygen species (free radicals), damaging those cells and causing necrosis. Once the drug is stopped, kidney function often recovers, but not always completely, especially with higher cumulative doses or long therapy. Risk factors: dehydration, existing CKD, liver disease, low albumin, or when used together with other nephrotoxic drugs.Tip: When aminoglycosides are necessary, clinicians often monitor drug levels, adjust dose, ensure good hydration, and avoid other harmful drugs.

Vancomycin is a powerful antibiotic often used to treat resistant bacterial infections. But it’s not harmless: it has a known risk of kidney toxicity, especially when used at high doses or combined with other nephrotoxins (like aminoglycosides).The mechanism isn’t always simple, sometimes the patient’s illness (for example, sepsis) also contributes, but vancomycin independently increases the risk of acute kidney injury. Risk factors: high trough levels, prolonged therapy, and co-use of other kidney-stressing drugs.Tip: Drug dosing needs precision, and kidney function should be monitored closely during therapy.Contrast dyes used in imaging (CT scans, angiography) can sometimes spark contrast-induced nephropathy. These agents can reduce kidney blood flow, generate oxidative stress, and cause direct tubular toxicity. This is especially risky if someone already has impaired kidney function or is dehydrated.Risk factors: diabetes, existing CKD, dehydration, repeated contrast exposures.Tip: Before any diagnostic scan that uses dye, discuss your kidney health. Preventive measures include hydration, using the lowest contrast dose, and possibly alternative imaging strategies.

ACE inhibitors (like lisinopril) and ARBs (like losartan) are often life-saving drugs for hypertension, heart failure, and kidney disease, but under certain conditions, they can worsen kidney function transiently. These medicines dilate the efferent arteriole (part of the kidney’s blood filter), which lowers glomerular pressure. In most cases, that’s beneficial, but if combined with dehydration, NSAIDs, diuretics, or sudden drop in blood volume, it can contribute to acute kidney injury.Although this kind of decline is often reversible, it requires close monitoring.Adding to this Dr Gupta said, “ACE inhibitors and ARBs, such as lisinopril, enalapril, and ramipril, help regulate excessive blood pressure and protect the heart. They too can occasionally cause renal impairment, particularly if you are dehydrated or on other kidney-damaging medications. Diuretics drain excess fluid from the body and are often used to treat high blood pressure and edema. However, if not utilized properly, they can cause dehydration, putting stress on the kidneys and perhaps causing damage.”Tip: Never stop these medicines abruptly, but always inform your doctor if you’re vomiting, dehydrated, or taking other high-risk drugs.

What we need to know

Hidden risk in “safe” meds: Over-the-counter painkillers (NSAIDs) are often underestimated. People think they’re harmless, but over time and especially in vulnerable individuals, they can quietly erode kidney function.Synergy of harm: It’s not just one drug, the real damage often happens when multiple “almost safe” medicines interact (for example, NSAIDs + ACE inhibitors + diuretics).A person on painkillers long-term may not even realise their kidneys are being stressed, because the early signs are subtle. Empowering patients with knowledge (especially in India, where self-medication is common) could prevent a lot of silent damage.Disclaimer: This article is for educational purposes only and does not replace medical advice. Always consult a qualified healthcare professional before changing or stopping any medication, especially if you have existing kidney issues or other health concerns.