Nefrotoxic

Nefrotoxic, or nephrotoxic, refers to substances or conditions that damage the kidneys and impair their ability to filter waste from the blood. Nephrotoxicity can lead to acute kidney injury or contribute to chronic kidney disease, depending on exposure duration, dose, and patient risk factors. It is a central consideration in pharmacology, toxicology, and environmental health.

Mechanisms vary: direct tubular toxicity causing cell injury and death (for example, aminoglycoside antibiotics and cisplatin); crystal formation in tubules leading to obstruction (acyclovir, methotrexate); hemodynamic disturbances reducing renal perfusion (nonsteroidal anti-inflammatory drugs, certain antibiotics); immune-mediated interstitial nephritis (penicillins, rifampin); and glomerular injury from certain drugs or metals. Chronic exposure to low levels or mixtures of toxins can cause progressive CKD.

Common nephrotoxins include aminoglycoside antibiotics (gentamicin, tobramycin), amphotericin B, cisplatin and other platinum-containing chemotherapies, calcineurin inhibitors (cyclosporine, tacrolimus), radiographic contrast agents, nonsteroidal anti-inflammatory drugs, diuretics in dehydration, heavy metals such as lead and cadmium, and solvents like toluene. Analgesic and herbal preparations have historically been linked to kidney injury in some populations.

Clinical management focuses on identifying and removing the offending agent, correcting hemodynamic disturbances, ensuring adequate hydration, and monitoring kidney function. Dose adjustments and alternative therapies may be required in kidney disease. In severe cases, temporary dialysis can support vital functions. Prevention includes careful prescribing, avoiding concurrent nephrotoxins, and renal function monitoring after exposure.