NEPHROTOXICITY

Nephrotoxicity is a poisonous effect of some substances, both toxic substances and medication, on the kidney. There are various forms of toxicity^[1]. It should not be confused with the fact that some medications have a predominantly renal excretion and need their dose adjusted for the decreased renal function (e.g. heparin).

Nephrotoxins are chemicals displaying nephrotoxicity.

The nephrotoxic effect of most drugs is more profound in patients who already have renal impairment. Some drugs may affect renal function in more than one way.

Types of toxicity

Cardiovascular

• General: diuretics, β-blockers, vasodilator agents
• Local: ACE inhibitors, ciclosporin

Direct tubular effect

• Proximal convoluted tubule: Aminoglycoside antibiotics (e.g. gentamicin), amphotericin B, cisplatin, radiocontrast media, immunoglobulins, mannitol
• Distal tubule: NSAIDs (eg aspirin, ibuprofen, diclofenac), ACE inhibitors, ciclosporin, lithium salts, cyclophosphamide, amphotericin B
• Tubular obstruction: sulphonamides, methotrexate, aciclovir, polyethylene glycol

Acute interstitial nephritis

• β-lactam antibiotics, vancomycin, rifampicin, sulphonamides, ciprofloxacin, NSAIDs, ranitidine, cimetidine, furosemide, thiazides, phenytoin

Acute glomerulonephritis

• penicillamine

Causes of diabetes insipidus

• lithium salts
• amphotericin B
• fluoride
• demeclocycline
• foscarnet

References

1. ↑  Galley HF. Can acute renal failure be prevented? J R Coll Surg Edinb 2000;45(1):44-50. Fulltext. PMID 10815380.

See also

• Toxicity
• Neurotoxicity
• Ototoxicity

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