Non-drug-induced nephrotoxicity

Abstract

Several drugs and other compounds can induce acute and/or chronic nephrotoxicity. The goal of this study was to review clinical features of nephrotoxicity induced by 'atypical' or 'unconventional' agents, such as environmental agents (metals, minerals, animals), food agents (mushrooms, aristolochic acid, medicinal traditional herbals, dietary supplements, melamine), drugs, and other products (ethylene glycol). Nephrotoxicity varies according to local background, dependent on different food and cultural customs, as well as to differences in local fauna and flora. The incidence of such a phenomenon is not well known. Many different pathophysiological pathways are involved, and the spectrum of renal lesions is rather wide. 'Epidemic nephrotoxicity' may occur, as recently illustrated by the melamine epidemics in Chinese infants receiving powdered milk formulas; a rapid reaction to unusual increased frequency of acute kidney injury and nephrolithiasis in young children has led to a rapid analysis from international experts, with subsequent recommendations for diagnosis and care. Nephrotoxicity should be considered when there is any unexplained renal impairment, especially in children.

Herbal medicines and chronic kidney disease

“…This hypothesis, however, was not pursued. A number of aetiological factors, including heavy metal intoxication, trace metal deficiency, toxicity of hydrocarbons leached from coal deposits and even viruses, were proposed from time to time 56–58 . Ochratoxin, a mycotoxin implicated in porcine nephropathy, has received special attention 59 .…”

“…A number of aetiological factors, including heavy metal intoxication, trace metal deficiency, toxicity of hydrocarbons leached from coal deposits and even viruses, were proposed from time to time. [56][57][58] Ochratoxin, a mycotoxin implicated in porcine nephropathy, has received special attention. 59 High quantities of ochratoxin have been detected in food items in endemic areas, 60 and patients with BEN have been shown to have high blood and urinary levels of the toxin.…”

The size of melamine-induced stones is dependent on the melamine content of the formula fed, but not on duration of exposure

“…2. The prevalence of urinary stones was diverse among different regions, and male infants who were younger than 3 years were more susceptible than female infants [3]. 3.…”

The current status of biomarkers for predicting toxicity

“…[58,59], heavy metals (cadmium, lead, mercury, arsenic, uranium, etc.) [60–66], and other endemic toxins (ochratoxin A, aristolochic acid) [67–72] represent a very important etiologic factor in hospital and communityacquired kidney disease [73,74]. Avid tubular uptake of these drugs/environmental contaminants increases intracellular concentrations of toxic agents multifold, leading to alteration of renal hemodynamics, interstitial nephritis, tubular toxicity and obstruction by deposition of the metabolites [75].…”