Current Perspectives on Drug-Induced Nephrotoxicity

Review Article

Abstract

Nephrotoxicity is characterized by kidney injury resulting from exposure to various therapeutic agents and environmental toxins. The kidney's unique anatomical and physiological features make it particularly vulnerable to toxic insults through multiple pathways, including direct tubular damage, oxidative stress, inflammation, and vascular injury. Common nephrotoxic agents encompass aminoglycoside antibiotics, nonsteroidal anti-inflammatory drugs, radiocontrast media, chemotherapeutic agents, and heavy metals. Recent advances in molecular biology have enhanced our knowledge of cellular mechanisms underlying nephrotoxic injury, revealing complex interactions between drug metabolism, cellular stress responses, and tissue repair pathways. Novel biomarkers like kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and interleukin-18 show promise for early detection of kidney injury, potentially enabling timely intervention before irreversible damage occurs. Prevention measures focus on risk assessment, drug dosing optimization, and protective interventions, while management approaches include therapeutic drug monitoring, supportive care, and targeted therapies. Emerging technologies in artificial intelligence and pharmacogenomics offer new possibilities for predicting individual susceptibility to nephrotoxicity and personalizing treatment approaches. Significant challenges remain in early detection, risk stratification, and development of effective nephroprotective agents despite the recent progress