Nephrotoxikus

Nephrotoxikus, or nephrotoxic in English, describes substances or agents that can cause damage to the kidneys. The term is used in pharmacology, toxicology, and clinical medicine to categorize compounds that impair renal function. Nephrotoxicity is a common cause of acute kidney injury (AKI) and can result from drugs, environmental toxins, metabolic byproducts, or endogenous insults.

Mechanisms of nephrotoxicity include direct injury to renal tubular epithelial cells, especially in the proximal tubules; glomerular injury; crystal formation within the tubules; ischemic injury from altered renal blood flow; oxidative stress and inflammation; and damage from substances released during muscle breakdown (rhabdomyolysis) such as myoglobin. The kidneys' high blood flow and concentration of filtered substances make them particularly vulnerable to toxic insult.

Common nephrotoxic agents span multiple categories. They include aminoglycoside antibiotics (for example, gentamicin, tobramycin); platinum-based chemotherapeutics like cisplatin; antifungals such as amphotericin B; nonsteroidal anti-inflammatory drugs (NSAIDs); iodinated contrast media used in imaging; certain antiviral drugs; and some herbal or dietary products containing nephrotoxic compounds (notably aristolochic acid). Environmental exposure to heavy metals such as lead and cadmium, and secondary toxins from rhabdomyolysis, also contribute. Risk is increased with dehydration, advanced age, preexisting kidney disease, diabetes, hypertension, and concomitant use of multiple nephrotoxins.

Diagnosis relies on a temporal association between exposure and kidney function decline, with monitoring of serum creatinine, urine output, and urinalysis. Management centers on removing or reducing exposure, ensuring adequate hydration, correcting electrolyte disturbances, adjusting drug doses, and providing supportive care. In severe cases, renal replacement therapy may be required. Prevention focuses on minimizing exposure, careful dosing, and monitoring kidney function during treatment. Prognosis varies with the toxin and patient factors, ranging from reversibility after cessation to lasting kidney damage.