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Concept
Nephrotoxicity
Summary
Nephrotoxicity is toxicity in the kidneys. It is a poisonous effect of some substances, both toxic chemicals and medications, on kidney function. There are various forms, 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).
General: diuretics, β-blockers, vasodilator agents
Local: ACE inhibitors, ciclosporin, tacrolimus.
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.
Main article : Acute interstitial nephritis
β-lactam antibiotics, vancomycin, rifampicin, sulphonamides, ciprofloxacin, NSAIDs, ranitidine, cimetidine, furosemide, thiazides, phenytoin.
Lithium salts
Ciclosporin
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
Lithium salts
Amphotericin B—reversible at low doses, irreversible at high doses
Fluoride
Demeclocycline
Foscarnet
Lead, 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
Nephrotoxicity is usually monitored through a simple blood test.
Official source
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