Nephrotoxics

PRE-RENAL

• antihypertensives
  diuretics

SMALL VESSEL DISEASE

Haemodynamic

• NSAIDs
  ACE-I, ARBs
  radio-contrast
  cyclosporin, tacrolimus
  noradrenaline, cocaine

Thrombotic microangiopathic

• cyclosporin, tacrolimus
  mitomycin C
  clopidogrel
  quinine
  oral contraceptives

GLOMERULAR DISEASE

Rapidly progressive glomerulonephritis

• D-penicillamine
  hydralazine
  propylthiouracil
  organic solvents
  silica compounds
  amphetamines

ACUTE TUBULAR NECROSIS

• amphotericin
  aminoglycosides
  cisplatin
  ifosfamide
  paracetamol
  heavy metals
  herbal remedies
  radio-contrast agents
  pentamide
  organic solvents
  herbicides (paraquat)
  intravenous immunoglobulin

INTRATUBULAR OBSTRUCTION

• crystal formation
  acyclovir
  ethylene glycol
  sulphonamide antibiotics
  methotrexate
  indinavir
  triamterene

ACUTE ALLERGIC INTERSTITIAL NEPHRITIS

• Proton-pump inhibitors
  Antibiotcs – penicillins, cephalosporins, rifampicin, sulfamethoxazole, ciprofloxacin
  NSAIDs
  Loop and thiazide diuretics
  allopurinol
  cimetidine
  mesalazine
  analgesics

POST-RENAL OBSTRUCTION

• Papillary necrosis – NSAIDs, compound analgesics
  Urinary retention – anticholinergics, tricyclic antidepressants

For clarity, blood vessels not shown

The nephron: a single renal unit spans the kidney cortex and medulla Renal blood flow: Urine is this blood, after having been first filtered and then modified. [Wikimedia Commons] Blood is filtered at the glomerulus Filtered blood (urine) is modified by clever use of a counter-current mechanism Nephron molar solute transport [Wikimedia Commons] Renal conservation of bicarbonate [Wikimedia Commons]