Drug Nephrotoxicity: An Overview

The kidney is the major site of damage from many drugs and chemicals that are used in clinical medicine and are present in our environment.The reason for the commonly observed propensity of drugs and chemicals to cause renal dysfunction is based on the relatively high blood flow of the kidney relative to its inass and the unique property of kidney tubular epithelium with its countercurrent arrangement to concentrate the urine and its constituents.If these constituents are in the form of' drugs and chemicals, the local epithelium is exposed to much higher concentrations than normally encountered in other tissues.It is clear that most of the syndromes with which clinical nephrologists are confronted can be caused by drugs and chemicals.This paper covers common drug-induced acute and chronic renal failure.However, drug-induced nephrotoxicity should be prominent in the differential diagnosis of all renal disorders. ACUTE RENAL FAILUREAcute renal failure secondary to nephrotoxic drugs can be a result of direct tubular damage.The prototypic class of drugs causing this type of renal dysfunction are the aminoglycoside antibiotics.Other drugs compromise renal function by causing decrements in renal blood flow, particularly in predisposed individuals.Drugs in this category include nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, and immunosuppressive drugs such as cyclosporine. AMINOGLYCOSIDE NEPHROTOXICITWAminoglycosides are still widely used in clinical medicine beca.use of their favorable antimicrobial efficacy against gram-negative organisms.Dose-related nephrotoxicity and