nephrotoxic

Nephrotoxic refers to substances or exposures that damage the kidneys and can cause nephrotoxicity, acute kidney injury, or progression to chronic kidney disease. The term covers medicines, toxins, contrast agents, and metabolic disturbances that impair renal function.

Common nephrotoxic agents include certain medications such as aminoglycoside antibiotics (for example gentamicin), platinum-based chemotherapy (cisplatin and related drugs), amphotericin B, nonsteroidal anti-inflammatory drugs (NSAIDs), and some antivirals at high doses; radiographic iodinated contrast media; heavy metals like lead and mercury; solvent exposures; and conditions causing rhabdomyolysis or myoglobinuric injury.

Mechanisms of injury vary and include direct tubular toxicity, glomerular injury in some cases, medullary ischemia due to reduced renal blood flow, crystal or pigment precipitation leading to obstruction, and oxidative stress with inflammation. The result is impaired kidney function, which may present as acute kidney injury with reduced urine output, elevated serum creatinine, electrolyte disturbances, and, in some cases, distal tubular dysfunction.

Diagnosis relies on a history of exposure, temporal association with offending agents, and monitoring of kidney function; urinalysis may show tubular or glomerular findings, and imaging helps assess obstruction or structural problems. Management centers on stopping or avoiding the offending nephrotoxin, correcting volume status and electrolyte abnormalities, adjusting drug dosages for kidney function, and providing supportive care. Dialysis may be required in severe cases.

Prevention focuses on using less nephrotoxic alternatives when possible, ensuring adequate hydration, careful dosing and monitoring in at-risk patients (elderly, CKD), and avoiding multiple nephrotoxins simultaneously.