Editing Nephrotoxicity

{{Short description|Toxicity in the kidneys}}
'''Nephrotoxicity''' is [[toxicity]] in the [[kidney]]s. It is a [[poison]]ous effect of some [[chemical substance|substances]], both toxic chemicals and [[pharmaceutical drug|medications]], on [[kidney function]].<ref name=":0">{{Cite journal|last1=Abyar|first1=Selda|last2=Khandar|first2=Ali Akbar|last3=Salehi|first3=Roya|last4=Abolfazl Hosseini-Yazdi|first4=Seyed|last5=Alizadeh|first5=Effat|last6=Mahkam|first6=Mehrdad|last7=Jamalpoor|first7=Amer|last8=White|first8=Jonathan M.|last9=Shojaei|first9=Motahhareh|last10=Aizpurua-Olaizola|first10=O.|last11=Masereeuw|first11=Rosalinde|date=December 2019|title=In vitro nephrotoxicity and anticancer potency of newly synthesized cadmium complexes|journal=Scientific Reports|language=en|volume=9|issue=1|pages=14686|doi=10.1038/s41598-019-51109-9|issn=2045-2322|pmc=6789105|pmid=31604983|bibcode=2019NatSR...914686A }}</ref> There are various forms,<ref name="pmid10815380 ">{{cite journal |author=Galley HF |title=Can acute renal failure be prevented |journal=J R Coll Surg Edinb |volume=45 |issue=1 |pages=44–50 |year=2000 |pmid=10815380 |url=http://www.rcsed.ac.uk/journal/vol45_1/4510008.htm |url-status=dead |archive-url=https://web.archive.org/web/20051018104433/http://www.rcsed.ac.uk/journal/vol45_1/4510008.htm |archive-date=2005-10-18 }}</ref> and some drugs may affect kidney function in more than one way. '''Nephrotoxins''' are substances displaying nephrotoxicity.

Nephrotoxicity should not be confused with some medications predominantly excreted by the kidneys needing their dose adjusted for the decreased kidney function (e.g., [[heparin]], lithium).

==Types of toxicity==

===Cardiovascular===
* General: [[diuretics]], [[Beta blocker|β-blockers]], [[vasodilator]] agents
* Local: [[ACE inhibitor]]s, [[ciclosporin]],<ref name="pmid19218475 ">{{cite journal |vauthors=Naesens M, Kuypers DR, Sarwal M |title=Calcineurin inhibitor nephrotoxicity |journal=Clin. J. Am. Soc. Nephrol. |volume=4 |issue= 2 |pages=481–509 |year=2009 |pmid=19218475  |doi=10.2215/CJN.04800908|doi-access=free }}</ref> [[tacrolimus]].<ref name="pmid19218475 "/>

===Direct tubular effect===
* [[Proximal convoluted tubule]]: [[Aminoglycoside]] antibiotics (e.g., [[gentamicin]]), [[amphotericin B]], [[cisplatin]], [[radiocontrast]] media, [[immunoglobulin]]s, [[mannitol]]
* [[Distal tubule]]: [[NSAIDs]] (e.g. [[aspirin]], [[ibuprofen]], [[diclofenac]]), ACE inhibitors, ciclosporin, [[lithium salt]]s, [[cyclophosphamide]], [[amphotericin B]]
* Tubular obstruction: [[sulfonamide (medicine)|sulphonamides]], [[methotrexate]], [[aciclovir]], [[diethylene glycol]], [[triamterene]].

===Acute interstitial nephritis===
Main article : [[interstitial nephritis|Acute interstitial nephritis]]
* [[Beta-lactam antibiotic|β-lactam antibiotics]], [[vancomycin]], [[rifampicin]], [[sulfonamide (medicine)|sulphonamides]], [[ciprofloxacin]], [[NSAID]]s, [[ranitidine]], [[cimetidine]], [[furosemide]], [[thiazide]]s, [[phenytoin]].

===Chronic interstitial nephritis===
* [[Lithium salts]]
* [[Ciclosporin]]<ref name="QBanks">USMLE WORLD QBanks 2009, Step1, Pharmacology, Q74</ref>

===Acute glomerulonephritis===
Drug-induced glomerular disease is not common but there are a few drugs that have been implicated. Glomerular lesions occur primarily through immune-mediated pathways rather than through direct drug toxicity.
* [[Heroin]] and [[Pamidronate]] are known to cause focal segmental glomerulosclerosis
* [[Gold salts]] therapy can cause membranous nephropathy<ref name="QBanks" />
* [[Penicillamine]]

===Causes of diabetes insipidus===
* [[Lithium salt]]s
* [[Amphotericin B]]—reversible at low doses, irreversible at high doses
* [[Fluoride]]
* [[Demeclocycline]]
* [[Foscarnet]]

===Other nephrotoxins===
* [[Lead]], [[uranium]], [[Mercury (element)|mercury]], and [[cadmium]] salts<ref name=":0" />
* [[Aristolochic acid]], found in some plants and in some herbal supplements derived from those plants, has been shown to have nephrotoxic effects on humans.
* [[Rhubarb]] contains some nephrotoxins which can cause inflammation of the [[Kidney|kidneys]] in some people.
* [[Fumaric acid]], aka food additive E297, is nephrotoxic in high doses<ref name=ecscfa>European Commission: {{cite web |url=http://ec.europa.eu/food/fs/sc/scan/out112_en.pdf |title=European Commission Report of the Scientific Committee on Animal Nutrition on the Safety of Fumaric Acid |access-date=2014-03-07}}</ref>
* [[Lilium]] is very toxic to cats, often resulting in death by [[acute kidney failure]], or permanent renal dysfunction.<ref>{{Cite journal |last=Langston |first=Cathy E. |date=2002-01-01 |title=Acute renal failure caused by lily ingestion in six cats |url=https://avmajournals.avma.org/view/journals/javma/220/1/javma.2002.220.49.xml |journal=Journal of the American Veterinary Medical Association |volume=220 |issue=1 |pages=49–52 |doi=10.2460/javma.2002.220.49 |issn=0003-1488}}</ref>

==Diagnosis==
Nephrotoxicity is usually monitored through a simple blood test. A decreased [[creatinine clearance]] indicates poor kidney function. In interventional radiology, a patient's creatinine clearance levels are all checked prior to a procedure.{{citation needed|date=April 2022}}

[[Serum creatinine]] is another measure of [[kidney function]], which may be more useful clinically when dealing with patients with early kidney disease. Normal creatinine level is between 80 - 120 μmol/L.{{citation needed|date=April 2022}}

==Etymology==
The word ''nephrotoxicity'' ({{IPAc-en|ˌ|n|ɛ|f|r|oʊ-|t|ɒ|k|ˈ|s|ɪ|s|ᵻ|t|i}}) uses [[classical compound|combining forms]] of ''[[wikt:nephro-#Prefix|nephro-]]'' + ''[[wikt:tox-#Prefix|tox-]]'' + ''[[wikt:-icity#Suffix|-icity]]'', yielding "kidney poisoning".{{citation needed|date=March 2023}}

==See also==
* [[Contrast-induced nephropathy]]
* [[Toxicity]]
* [[Neurotoxicity]]
* [[Ototoxicity]]
* [[Onconephrology]]

==References==
{{reflist}}

==Further reading==
* {{cite journal |doi=10.1038/ncpneph0076 |title=Drug-associated renal dysfunction and injury |year=2006 |last1=Choudhury |first1=Devasmita |last2=Ahmed |first2=Ziauddin |journal=Nature Clinical Practice Nephrology |volume=2 |issue=2 |pages=80–91 |pmid=16932399|s2cid=42733127 }}
* {{cite journal |pmid=15957551 |year=2005 |last1=Szeto |first1=CC |last2=Chow |first2=KM |title=Nephrotoxicity related to new therapeutic compounds |volume=27 |issue=3 |pages=329–33 |journal=Renal Failure |doi=10.1081/jdi-56595|s2cid=6111262 |doi-access=free }}

{{Authority control}}

[[Category:Toxins by organ system affected]]
[[Category:Nephrology]]