nefrotoxis

Nefrotoxis, also known as nephrotoxicity, refers to kidney damage caused by exposure to toxic substances, including drugs, metals, and environmental agents. It can manifest as acute kidney injury or as chronic decline in kidney function and is a significant cause of drug-related kidney injury.

Damage from nephrotoxins occurs through several mechanisms. Direct tubular toxicity can injure kidney cells; hemodynamic changes may reduce renal perfusion; crystal formation in the tubules can obstruct flow; interstitial inflammation or immune-mediated injury can contribute; and in some cases, muscle breakdown or hemolysis releases substances that further harm the kidneys.

Common nephrotoxins include certain medications such as aminoglycoside antibiotics, nonsteroidal anti-inflammatory drugs, platinum-based chemotherapy (e.g., cisplatin), radiographic contrast agents, amphotericin B, and some antivirals. Heavy metals, solvents, and some herbal or dietary supplements also carry nephrotoxic potential. The risk is heightened with high-dose or prolonged exposure, dehydration, pre-existing kidney disease, advanced age, and coadministration of multiple nephrotoxins.

Diagnosis relies on a history of exposure to a potential nephrotoxin, together with laboratory findings of reduced kidney function (elevated serum creatinine and BUN) and electrolyte disturbances. Urinalysis may show proteinuria, hematuria, or abnormal sediment. Imaging and, in uncertain cases, kidney biopsy may be used to characterize the injury.

Prevention focuses on avoiding or minimizing exposure, dose adjustment for susceptible individuals, adequate hydration, and careful monitoring of kidney function during treatment. Management consists of stopping the offending agent, treating complications, and, when necessary, providing renal replacement therapy. Risk assessment and protective strategies are essential in clinical settings to mitigate nephrotoxicity.