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Mechanisms of Drug-Induced Nephrotoxicity

Chapter
First Online:
Part of the Handbook of Experimental Pharmacology book series (HEP, volume 196)

Abstract

Drug-induced nephrotoxicity is a common complication of several medications and diagnostic agents. It is seen in both inpatient and outpatient settings with variable presentations ranging from mild, reversible injury to advanced kidney disease. Manifestations of drug-induced nephrotoxicity include acid–base abnormalities, electrolyte imbalances, urine sediment abnormalities, proteinuria, pyuria, hematuria, and, most commonly, a decline in the glomerular filtration rate. The mechanisms of drug-induced nephrotoxicity may differ between various drugs or drug classes, and they are generally categorized based on the histological component of the kidney that is affected. Aminoglycoside antibiotics, radiocontrast media, conventional nonselective nonsteroidal anti-inflammatory drugs, and selective cyclooxygenase-2 inhibitors, amphotericin B, and angiotensin-converting enzyme inhibitors have been frequently implicated. This chapter reviews the clinical presentation and basic mechanisms of drug-induced nephrotoxicity.

Keywords

Nephrotoxicity Kidney disease Acute kidney injury 

Abbreviations

ACEI

Angiotensin-converting enzyme inhibitor

AIN

Allergic interstitial nephritis

AKI

Acute kidney injury

ANCA

Antineutrophil cytoplasmic antibody

ARB

Angiotensin II receptor blocker

ATN

Acute tubular necrosis

BUN

Blood urea nitrogen

CKD

Chronic kidney disease

COX

Cyclooxygenase

ESRD

End-stage renal disease

FSGS

Focal segmental glomerulosclerosis

GFR

Glomerular filtration rate

HIV

Human immunodeficiency virus

NSAID

Nonsteroidal anti-inflammatory drug

PGE2

Prostaglandin E2

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© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Kidney Research Institute Department of Medicine Division of NephrologyUniversity of WashingtonSeattleUSA

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