nefrotooksilisteks

Nefrotooksilised is an Estonian term used in toxicology and nephrology to describe substances and factors that cause nephrotoxicity, i.e., injury or dysfunction of the kidneys due to toxic effects. The concept covers a range of agents, from prescription drugs and contrast media to heavy metals and certain toxins.

Causes and categories: Common nefrotoksilised agents include medications such as aminoglycoside antibiotics (for example, gentamicin), platinum-based chemotherapy (cisplatin), and amphotericin B. Radiographic iodinated contrast agents can also be nephrotoxic, as can nonsteroidal anti-inflammatory drugs under some conditions. Other examples are heavy metals (lead, mercury), solvents, and certain illicit drugs. The risk is higher in people with preexisting kidney disease, dehydration, advanced age, multiple medical conditions, and in cases of high-dose or prolonged exposure.

Mechanisms: Nephrotoxicity can manifest as tubular injury (notably the proximal tubule), glomerular injury, or interstitial nephritis. Mechanisms include direct cellular toxicity, oxidative stress, reduced renal perfusion leading to ischemia, immune-mediated damage, and the formation of obstructive casts within the nephron.

Clinical features and diagnosis: Presentation ranges from asymptomatic rises in serum creatinine and decreased estimated GFR to acute kidney injury with reduced urine output and electrolyte disturbances. Urinalysis may reveal proteinuria, hematuria, or tubular casts. Diagnosis typically relies on the timing of exposure, laboratory findings, and, when needed, imaging or renal biopsy to clarify the injury pattern.

Management and prevention: Key steps are identifying and stopping the offending agent when possible, ensuring adequate hydration, adjusting doses, and avoiding additional nephrotoxins. In some cases, specific treatments (such as chelation for heavy metals) are indicated. Prevention focuses on risk assessment, appropriate dosing, hydration, and monitoring kidney function in at‑risk patients.