Mechanisms of Drug-Induced Nephrotoxicity

  • Thomas D. Nolin
  • Jonathan HimmelfarbEmail author
Part of the Handbook of Experimental Pharmacology book series (HEP, volume 196)


Drug-induced nephrotoxicity is a common complication of several medications and diagnostic agents. It is seen in both inpatient and outpatient settings with variable presentations ranging from mild, reversible injury to advanced kidney disease. Manifestations of drug-induced nephrotoxicity include acid–base abnormalities, electrolyte imbalances, urine sediment abnormalities, proteinuria, pyuria, hematuria, and, most commonly, a decline in the glomerular filtration rate. The mechanisms of drug-induced nephrotoxicity may differ between various drugs or drug classes, and they are generally categorized based on the histological component of the kidney that is affected. Aminoglycoside antibiotics, radiocontrast media, conventional nonselective nonsteroidal anti-inflammatory drugs, and selective cyclooxygenase-2 inhibitors, amphotericin B, and angiotensin-converting enzyme inhibitors have been frequently implicated. This chapter reviews the clinical presentation and basic mechanisms of drug-induced nephrotoxicity.


Nephrotoxicity Kidney disease Acute kidney injury 



Angiotensin-converting enzyme inhibitor


Allergic interstitial nephritis


Acute kidney injury


Antineutrophil cytoplasmic antibody


Angiotensin II receptor blocker


Acute tubular necrosis


Blood urea nitrogen


Chronic kidney disease




End-stage renal disease


Focal segmental glomerulosclerosis


Glomerular filtration rate


Human immunodeficiency virus


Nonsteroidal anti-inflammatory drug


Prostaglandin E2


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Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Kidney Research Institute Department of Medicine Division of NephrologyUniversity of WashingtonSeattleUSA

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