Nephrotoxicity Poisonous effect of some substances both toxic chemicals and medication. Nephrotoxins are chemicals displaying nephrotoxicity.

Renal toxicity can be a result of hemodynamic changes, direct injury to cells and tissues, inflammatory tissue injury, obstruction of renal tubules.

Direct tubular effect PCT DCT Tubular obstruction Aminoglycoside (gentamicin),amphotericin B,cisplatin, Radio contrast media DCT NSAIDs,ACE inhibitors,cyclosporin,lithium salts,cyclophosphamide. Tubular obstruction Sulphonamides,methotrexate,triamterene.

Acute interstitial nephritis Beta lactam antibiotics Vancomycin Rifampicin Sulfonamides NSAIDs

Other causes of renal damage Biologic therapy Interleukin 2 or interferon alpha Low BP Lot of protein in diet Diabetes mellitus

When kidney damage occurs body is unable to rid of excess urine and other wastes. Electrolytes e.g K+, Mg+ are elevated. Rise of BUN and creatinine Cause could be dehydration or renal How diagnosed? Normal values Bun ______10-25mg/dl Creatinine________0.7- 1.4 mg/dl

Nephrotoxic effect of drugs may be added when administered together. Dose adjustment of drugs is made for drugs which are excreted via kidney if renal function is decreased.