A Synopsis of Current Theories on Drug-Induced Nephrotoxicity

Abstract

The overriding goal of the treatment of patients is its effectiveness and safety. However, all medications currently being used also exert some adverse pharmaceutical reactions, which may be regarded as an unintended but inevitable cost of pharmacotherapy. The kidney, as the main organ that eliminates xenobiotics, is an organ especially predisposed and vulnerable to the toxic effects of drugs and their metabolites during their excretion from the body. Moreover, some drugs (e.g., aminoglycosides, cyclosporin A, cisplatin, amphotericin B, and others) have a “preferential” nephrotoxicity potential, and their use is associated with an increased risk of kidney damage. Drug nephrotoxicity is, therefore, both a significant problem and a complication of pharmacotherapy. It should be noted that, currently, there is no generally recognized definition of drug-induced nephrotoxicity and no clear criteria for its diagnosis. This review briefly describes the epidemiology and diagnosis of drug-induced nephrotoxicity and characterizes its pathomechanisms, including immunological and inflammatory disturbances, altered kidney blood flow, tubulointerstitial injury, increased lithogenesis–crystal nephropathy, rhabdomyolysis, and thrombotic microangiopathy. The study also lists the basic drugs with nephrotoxicity potential and provides a short overview of the preventive methods for reducing the risk of drug-related kidney damage developing.

Lower Urinary Tract Disorders as Adverse Drug Reactions—A Literature Review

“…The second group of drug-induced urinary stones are those classified as a sub-type of “metabolic stones”, due to the fact that treatment with these drugs contributes to the development of metabolic disturbances that facilitate the crystallisation of endogenous lithogenic substances. Many drugs may induce urinary stone development by affecting the pH of urine (in such a way that the solubility of many endogenous substances decreases), the alternation of the glomerular filtration and tubular secretion/reabsorption of the endogenous substances, or impairing the balance and action of crystallisation promoters/inhibitors [ 52 , 58 , 59 , 60 ]. The drugs contributing to drug-induced kidney stone development are listed in Table 4 .…”

The Antioxidant, Antibacterial and Cell-Protective Properties of Bioactive Compounds Extracted from Rowanberry (Sorbus aucuparia L.) Fruits In Vitro

“…One of their main functions represents the removal of xenobiotics—potentially nephrotoxic substances—that are transported to the organ in relatively high quantities, rendering them a prime candidate for drug toxicity. Due to their high metabolic activity, the proximal tubules are the most susceptible to the nephrotoxic effects of xenobiotics and pharmaceuticals [ 25 , 26 ]. Oxidative stress represents a key cause of drug-induced nephrotoxicity, as evidenced by increased generation of reactive oxygen species and mitochondrial dysfunction.…”

Urinary exosomes: a promising biomarker of drug-induced nephrotoxicity

“…DIN is the main causative factor of acute kidney injury (AKI), chronic kidney disease (CKD), acute renal failure (ARF), and end-stage renal disease (ESRD) ( 2 , 3 ). About 14–26% of adults and 16% of children may experience DIN during clinical medication, especially in the elderly, who may have multiple chronic diseases requiring multiple drug treatments ( 4 ). Drug-related renal dysfunction is usually reversible, and patients’ renal function will improve after drug withdrawal.…”