Nephrotoxicity is an important and preventable cause of nephrotoxin induced acute kidney injury (AKI) as well as chronic kidney disease (CKD). Drugs and toxins may cause renal injury based on several pathophysiological mechanisms. The spectrum of injury may vary from subtle to severe. The diagnosis of nephrotoxic injury requires a high index of suspicion. The common endogenous toxins like hemoglobin, myoglobin, and uric acid as well as exogenously administered drugs, heavy metals, and contrast agents are discussed in this chapter. The risk factors for nephrotoxicity; the various mechanisms of nephrotoxicity such as alteration of renal hemodynamics, acute tubular injury, acute interstitial nephritis, and tubular obstruction; the clinical features; and the relevant investigations are outlined. Various aspects of management and prevention, specific to each of these drugs and toxins, are also discussed.
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