Nefropatias toxicas

CORE CURRICULUM IN NEPHROLOGY
Toxic Nephropathies: Core Curriculum 2010
Mark A. Perazella, MD
INTRODUCTION
Toxic nephropathies are an important and relatively
common category of kidney damage.Although
they generally are reversible when detected
early, they may be permanent, leading to chronic
kidney disease (CKD). Toxic nephropathies are
defined primarily as kidney injury caused by anynumber of medications, diagnostic agents, alternative
products, herbal adulterants, or other toxin
exposures, which includes environmental agents
and chemicals. Because the kidney performs anumber of essential bodily functions, including
clearance of endogenous waste products, control
of volume status, maintenance of electrolyte and
acid-base balance, and modulation of endocrineactivity, loss of kidney function leads to a number
of clinical problems. Furthermore, metabolism
and excretion of exogenously administered
medications and environmental exposures is a
criticallyimportant function. In its role as the
primary eliminator of exogenous drugs and toxins,
the kidney is vulnerable to develop various
forms of injury.
General Categories of Toxic Nephropathies
●Therapeutic and diagnostic agents
● Alternative and complementary products
● Environmental compounds and chemicals
Drug and Toxicant Handling by the Kidney
● Metabolism and excretion of medications,environmental compounds/chemicals, and
other toxins
 Metabolism by cytochrome P450 (CYP450)
enzymes, conjugation with glutathione and
cysteine, and other metabolic pathways
 Clearance throughglomerular filtration
and/or tubular secretion
SUGGESTED READING
➢ Evenepoel P. Acute toxic renal failure. Best Pract Res
Clin Anaesthesiol. 2004;18:37-52.
➢ Guo X, Nzerue C. How to prevent, recognize,and
treat drug-induced nephropathy. Cleve Clin J Med.
2002;69(4):289-297.
➢ Perazella MA. Drug-induced nephropathy: an update.
Expert Opin Drug Saf. 2005;4:689-706.
➢ Singh NP, Ganguli A,...