Nephrotoxins

Abstract

The excretion of endogenous and exogenous compounds is a fundamental aspect of renal function, which, by necessity, exposes the kidney to high concentrations of these substances and their metabolites. Some of these compounds are “toxic” to the kidney and substances capable of causing renal damage or injury are termed “nephrotoxins.” While naturally occurring nephrotoxins exist and environmental exposures can cause injury, the focus of this chapter is on the pharmaceutical agents used to treat medical disease and its sequelae. While specific, ubiquitously prescribed agents are discussed in detail, equal weight is placed on highlighting core nephrotoxin concepts, illustrating the most commonly seen nephrotoxicity phenotypes, and describing the mechanisms by which these compounds cause injury. This foundation creates the context for discussing approaches to avoid, minimize, and manage the impact of nephrotoxin exposure. Although targeted treatments for nephrotoxic acute kidney injury do not yet exist, broad multidisciplinary strategies are capable of predicting, preventing, and mitigating the impact of these medications. Furthermore, a thorough understanding of the core concepts underpinning nephrotoxicity will allow future development of disease-specific interventions.