Accidental or deliberate overdose with the analgesic paracetamol can cause life-threatening liver damage. Likewise, extensive use of nonsteroidal anti-inflammatory drugs such as ibuprofen causes kidney damage in vulnerable patients (e.g. the elderly). In addition to these medicinal risks, liver and kidney damages accompany exposure to synthetic chemicals in the workplace or as environmental pollutants. Still other chemicals that harm the excretory organs are consumed as food contaminants. The vulnerability of the liver and kidney to xenobiotic toxicity raises the question as to why such chemicals often display ‘organ selectivity’ when inducing toxicity. This chapter explores the factors that render the liver and kidney susceptible to toxicity, while also surveying typical toxic responses in these organs (e.g. steatosis, fibrosis, cancer). The diverse mechanisms underlying excretory organ toxicity are illustrated for such classic toxicants as azidothymidine, carbon tetrachloride, paracetamol, troglitazone, cylindrospermopsin and trichloroethylene.
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