In the kidney, various compounds in the plasma are filtrated through glomeruli. Though the glomerular filtration of many plasma proteins is restricted because of their large molecular weights, still significant amount of proteins is filtered. The proteins filtered are reabsorbed in the proximal tubular cells almost completely. The mechanism involved in protein reabsorption is receptor-mediated endocytosis. Not only proteins but also drugs such as aminoglycoside antibiotics are taken up by receptor-mediated endocytosis in renal proximal tubules. Megalin is a large (ca. 600 kDa) endocytic receptor, which is abundantly expressed in renal proximal tubules, and recognizes various compounds such as lipoprotein lipase, aprotinin, transcobalamin-vitamin B12, apolipoprotein J/clusterin, RAP (receptor-associated protein), 25-(OH) vitamin D3-vitamin D binding protein complex as substrates. Albumin, a major plasma protein, was initially reported as a substrate for megalin, but recently the involvement of another protein, cubilin, in albumin endocytosis was indicated. Namely, albumin binds to cubilin, and albumin-cubilin complex binds to megalin for endocytosis; the hypothesis which should be tested further. Megalin is also suggested to be the receptor for endocytosis of aminoglycosides. We have studied the possible role of megalin in in vivo renal accumulation of aminoglycosides. The positive relationship between megalin expression and amikacin accumulation in renal cortex, either under normal or disease condition, strongly suggests that megalin acts as an endocytic receptor for aminoglycosides. There are two important functional proteins for endosomal acidification, which is important for overall endocytic process; these are vacuolar H+-ATPase (V-H+-ATPase) and chloride channel, ClC-5. Cisplatin, an anticancer drug, often induces nephrotoxicity, which is accompanied by albumin(protein) uria. In order to clarify the mechanisms underlying albuminuria by cisplatin, we examined the effect of cisplatin treatment on V-H+-ATPase activity in the kidney. Proton transporting activity as well as ATP hydrolysis activity of V-H+-ATPase was markedly inhibited by cisplatin treatment. Similarly, receptormediated endocytosis of albumin was inhibited by cisplatin in OK cells and in vivo in rats. Reabsorption of a megalin substrate, vitamin D binding protein, was also inhibited and excreted into the urine. These findings suggest that albumin (protein) uria induced by cisplatin would be due to inhibition of V-H+-ATPase. Receptor-mediated endocytosis in the kidney is physiologically and pathophisiologically important process. Also, understanding the receptor-mediated endocytosis would help to consider drug delivery systems, especially those for proteins and genes with large molecular weights.