The kidneys are vulnerable to various pharmacological and chemical agents. There are a number of reasons for this. The kidneys receive about 20% of the total body blood flow, a large volume per gram of tissue, and thus they are exposed to circulating toxic substances more than any other organs. By transcellular transportation, the renal tubules handle a large amount of substances, electrolytes and chemical solutes including toxic agents. High oxygen requirement of the proximal tubules makes this part of the organ highly sensitive to anoxia-inducing agents. The kidney also has an efficient countercurrent system and some chemicals are highly concentrated at the papillary tips of the renal medulla. The kidneys also provide with sites for immune reactions and also contain immunologically active cells. Drug-induced allergic vascullitis, acute and chronic interstitial nephritis, immune complex mediated or anti-glomerular basement glomerulonephritis are reported in animal models and in human cases.
Manifestations of drug induced nephropathy are various.
These include;
1) Acute tubular necrosis
2) Obsrtuctive urophropathy
3) Acute interstitial nephtitis
4) Chronic intersitial nephritis
5) Proteinuria, nephrotic syndrome, and glomerulonephritis
6) Change in concentration/dilution mechanism,
Change in acid-base balance
In the following, major drugs and related nephropathies are discussed.
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