Pharmacology behind Common Drug Nephrotoxicities

Abstract

Patients are exposed to numerous prescribed and over-the-counter medications. Unfortunately, drugs remain a relatively common cause of acute and chronic kidney injury. A combination of factors including the innate nephrotoxicity of drugs, underlying patient characteristics that increase their risk for kidney injury, and the metabolism and pathway of excretion by the kidneys of the various agents administered enhance risk for druginduced nephrotoxicity. This paper will review these clinically relevant aspects of drug-induced nephrotoxicity for the clinical nephrologist.

Ameliorative effect of a standardized polyherbal combination in methotrexate-induced nephrotoxicity in the rat

“…Nephrotoxicity is a renal dysfunction that arises from direct exposure to environmental chemicals or as a side effect of many drugs such as some nonsteroidal anti-inflammatory drugs, aminoglycoside antibiotics, anticancer drugs, etc. (Perazella 2018). Methotrexate, a folic acid antagonist, is widely used in the treatment of various malignancies and inflammatory diseases.…”

Nephrotoxic Effects of Drugs

“…Acute kidney injury is the deterioration of the renal function over hours or days, resulting in the accumulation of toxic wastes and the loss of internal homeostasis. It can be caused by numerous etiologies [1,2], and medications are a relatively common cause of kidney injury among these injuries [3]. Drug-induced nephrotoxicity is a renal dysfunction that occurs as a result of direct or indirect exposure to nephrotoxic prescribed drugs, over-the-counter products, diagnostic agents, or alternative/complementary products (herbal remedies, natural products, nutritional supplements) that are widely available at most health food stores [3,4].…”

“…It can be caused by numerous etiologies [1,2], and medications are a relatively common cause of kidney injury among these injuries [3]. Drug-induced nephrotoxicity is a renal dysfunction that occurs as a result of direct or indirect exposure to nephrotoxic prescribed drugs, over-the-counter products, diagnostic agents, or alternative/complementary products (herbal remedies, natural products, nutritional supplements) that are widely available at most health food stores [3,4]. Druginduced nephrotoxicity is an extremely common condition and is responsible for a variety of pathological effects on the kidneys [4].…”

“…There is a growing incidence of druginduced glomerular disease, including direct cellular injury and immune-mediated injury [5]. However, kidney disease does not develop in all patients exposed to the various potential nephrotoxins [3]. The nephrotoxicity of medications, drugs, or other ingested substances is a complicated process that involves a combination of factors.…”

“…Potential nephrotoxic effect of the drug, comorbid diseases or conditions (underlying renal dysfunction, cardiovascular disease, diabetes, immunologic diseases, sepsis, etc. ), genetic determinants of drug metabolism and transport, immune response genes, drug dose and duration of therapy, drug characteristics (solubility, structure and charge), combinations of potential nephrotoxic drugs, urine pH, metabolic disturbances, older age (>65 year), and female sex are the common risk factors for drug-induced nephrotoxicity [1][2][3][4][5].…”