Toxic acute kidney injury

Abstract

The kidney is a major organ in the human body carrying out the essential metabolic functions. Metabolism and excretion of exogenously administered therapeutic and diagnostic agents as well as environmental exposures are other major functions of kidneys. Kidney is vulnerable to develop various form of injury via virtue of its role as the primary eliminator of exogenous drugs, and toxins. Toxic kidney injury is an important and relatively common category of kidney damage. Several classes of dissimilar toxicants target the kidney. Despite the widespread appreciation of the role of nephrotoxic agents in their contribution to acute kidney injury (AKI), these drugs continue to have an ongoing etiological role. Tubular injury initiated by toxins often results from a combination of acute renal vasoconstriction and direct cellular toxicity due to intracellular accumulation of the toxin, or, alternatively, may be mediated immunologically in case of interstitial nephritis. Patients with reduced renal functional reserve, cardiovascular co-morbidity, diabetes mellitus, and advanced age are at increased risk. Awareness of the range of toxins on the one hand and simple measures such as adequate pre-hydration of the patient and drug monitoring on the other hand may be sufficient to avoid drug-induced AKI or minimize its clinical severity in susceptible patients.