Nephrotoxicity
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Nephrotoxicity is a poisonous effect of some substances, both toxic chemicals and medications, on the kidney. There are various forms of toxicity. It should not be confused with the fact that some medications have a predominantly renal excretion and need their dose adjusted for the decreased renal function (e.g. heparin).
Nephrotoxins are chemicals displaying nephrotoxicity.
The nephrotoxic effect of most drugs is more profound in patients who already have renal impairment. Some drugs may affect renal function in more than one way.
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[edit] Types of toxicity
[edit] Cardiovascular
- General: diuretics, β-blockers, vasodilator agents
- Local: ACE inhibitors, ciclosporin
[edit] Direct tubular effect
- Proximal convoluted tubule: Aminoglycoside antibiotics (e.g. gentamicin), amphotericin B, cisplatin, radiocontrast media, immunoglobulins, mannitol
- Distal tubule: NSAIDs (eg aspirin, ibuprofen, diclofenac), ACE inhibitors, ciclosporin, lithium salts, cyclophosphamide, amphotericin B
- Tubular obstruction: sulphonamides, methotrexate, aciclovir, polyethylene glycol
[edit] Acute interstitial nephritis
- β-lactam antibiotics, vancomycin, rifampicin, sulphonamides, ciprofloxacin, NSAIDs, ranitidine, cimetidine, furosemide, thiazides, phenytoin
[edit] Acute glomerulonephritis
[edit] Causes of diabetes insipidus
[edit] Other nephrotoxins
- heavy metals interfere with enzymes of energy metabolism
- Aristolochic acid - found in some plants and, more dangerously, in some herbal supplements derived from those plants, has been shown to have Nephrotoxic effects on humans.
[edit] References
- ^ Galley HF. Can acute renal failure be prevented? J R Coll Surg Edinb 2000;45(1):44-50. Fulltext. PMID 10815380.
[edit] See also
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