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{{Short description|Toxicity in the kidneys}}Nephrotoxicity is toxicity in the kidneys. It is a poisonous effect of some substances, both toxic chemicals and medications, on kidney function.JOURNAL, Abyar, Selda, Khandar, Ali Akbar, Salehi, Roya, Abolfazl Hosseini-Yazdi, Seyed, Alizadeh, Effat, Mahkam, Mehrdad, Jamalpoor, Amer, White, Jonathan M., Shojaei, Motahhareh, Aizpurua-Olaizola, O., Masereeuw, Rosalinde, December 2019, In vitro nephrotoxicity and anticancer potency of newly synthesized cadmium complexes, Scientific Reports, en, 9, 1, 14686, 10.1038/s41598-019-51109-9, 2045-2322, 6789105, 31604983, 2019NatSR...914686A, There are various forms,JOURNAL, Galley HF, Can acute renal failure be prevented, J R Coll Surg Edinb, 45, 1, 44–50, 2000, 10815380,www.rcsed.ac.uk/journal/vol45_1/4510008.htm, dead,www.rcsed.ac.uk/journal/vol45_1/4510008.htm," title="web.archive.org/web/20051018104433www.rcsed.ac.uk/journal/vol45_1/4510008.htm,">web.archive.org/web/20051018104433www.rcsed.ac.uk/journal/vol45_1/4510008.htm, 2005-10-18, and some drugs may affect kidney function in more than one way. Nephrotoxins are substances displaying nephrotoxicity.Nephrotoxicity should not be confused with some medications predominantly excreted by the kidneys needing their dose adjusted for the decreased kidney function (e.g., heparin, lithium).

Types of toxicity

Cardiovascular

• General: diuretics, β-blockers, vasodilator agents
• Local: ACE inhibitors, ciclosporin,JOURNAL, Naesens M, Kuypers DR, Sarwal M, Calcineurin inhibitor nephrotoxicity, Clin. J. Am. Soc. Nephrol., 4, 2, 481–509, 2009, 19218475, 10.2215/CJN.04800908, free, tacrolimus.

Direct tubular effect

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

Acute interstitial nephritis

Main article : Acute interstitial nephritis

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

Chronic interstitial nephritis

• Lithium salts
• CiclosporinUSMLE WORLD QBanks 2009, Step1, Pharmacology, Q74

Acute glomerulonephritis

Drug-induced glomerular disease is not common but there are a few drugs that have been implicated. Glomerular lesions occur primarily through immune-mediated pathways rather than through direct drug toxicity.

• Heroin and Pamidronate are known to cause focal segmental glomerulosclerosis
• Gold salts therapy can cause membranous nephropathy
• Penicillamine

Causes of diabetes insipidus

• Lithium salts
• Amphotericin B—reversible at low doses, irreversible at high doses
• Fluoride
• Demeclocycline
• Foscarnet

Other nephrotoxins

• Lead, Uranium, mercury, and cadmium salts
• Aristolochic acid, found in some plants and in some herbal supplements derived from those plants, has been shown to have nephrotoxic effects on humans.
• Rhubarb contains some nephrotoxins which can cause inflammation of the kidneys in some people.
• Fumaric acid, aka food additive E297
• Orellanine

Diagnosis

Nephrotoxicity is usually monitored through a simple blood test. A decreased creatinine clearance indicates poor kidney function. In interventional radiology, a patient’s creatinine clearance levels are all checked prior to a procedure.{{citation needed|date=April 2022}}Serum creatinine is another measure of kidney function, which may be more useful clinically when dealing with patients with early kidney disease. Normal creatinine level is between 80 - 120 μmol/L.{{citation needed|date=April 2022}}

Etymology

The word nephrotoxicity ({{IPAc-en|ËŒ|n|É›|f|r|oÊŠ-|t|É’|k|ˈ|s|ɪ|s|áµ»|t|i}}) uses combining forms of (wikt:nephro-#Prefix|nephro-) + (wikt:tox-#Prefix|tox-) + (wikt:-icity#Suffix|-icity), yielding “kidney poisoning”.{{citation needed|date=March 2023}}

See also

• Contrast-induced nephropathy
• Toxicity
• Neurotoxicity
• Ototoxicity
• Onconephrology

References

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Further reading

• JOURNAL, 10.1038/ncpneph0076, Drug-associated renal dysfunction and injury, 2006, Choudhury, Devasmita, Ahmed, Ziauddin, Nature Clinical Practice Nephrology, 2, 2, 80–91, 16932399, 42733127,
• JOURNAL, 15957551, 2005, Szeto, CC, Chow, KM, Nephrotoxicity related to new therapeutic compounds, 27, 3, 329–33, Renal Failure, 10.1081/jdi-56595, 6111262, free,

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