nephrotoxicity nephrotoxicity nephrotoxicity is toxicity in the kidneys. it is a poisonous effect of some substances, both toxic chemicals and medications, on kidney function. there are various forms, and some drugs may affect kidney function in more than one way. nephrotoxins are substances displaying nephrotoxicity. nephrotoxicity should not be confused with some medications predominantly excreted by the kidneys needing their dose adjusted for the decreased kidney function (e.g., heparin, lithium). types of toxicity cardiovascular general: diuretics, β-blockers, vasodilator agents local: ace inhibitors, ciclosporin, tacrolimus. direct tubular effect proximal convoluted tubule: aminoglycoside antibiotics (e.g., gentamicin), amphotericin b, cisplatin, radiocontrast media, immunoglobulins, mannitol distal tubule: nsaids (e.g. aspirin, ibuprofen, diclofenac), ace inhibitors, ciclosporin, lithium salts, cyclophosphamide, amphotericin b tubular obstruction: sulphonamides, methotrexate, aciclovir, diethylene glycol, triamterene. acute interstitial nephritis main article : acute interstitial nephritis β-lactam antibiotics, vancomycin, rifampicin, sulphonamides, ciprofloxacin, nsaids, ranitidine, cimetidine, furosemide, thiazides, phenytoin. chronic interstitial nephritis lithium salts ciclosporin acute glomerulonephritis drug-induced glomerular disease is not common but there are a few drugs that have been implicated. glomerular lesions occur primarily through immune-mediated pathways rather than through direct drug toxicity. heroin and pamidronate are known to cause focal segmental glomerulosclerosis gold salts therapy can cause membranous nephropathy penicillamine causes of diabetes insipidus lithium salts amphotericin b—reversible at low doses, irreversible at high doses fluoride demeclocycline foscarnet other nephrotoxins lead, mercury and cadmium salts aristolochic acid, found in some plants and in some herbal supplements derived from those plants, has been shown to have nephrotoxic effects on humans. rhubarb contains some nephrotoxins which can cause inflammation of the kidneys in some people. fumaric acid, aka food additive e297 orellanine diagnosis nephrotoxicity is usually monitored through a simple blood test. a decreased creatinine clearance indicates poor kidney function. in interventional radiology, a patient's creatinine clearance levels are all checked prior to a procedure. serum creatinine is another measure of kidney function, which may be more useful clinically when dealing with patients with early kidney disease. normal creatinine level is between 80 - 120 μmol/l. etymology the word nephrotoxicity (/ˌnɛfroʊtɒkˈsɪsɪti/) uses combining forms of nephro- + tox- + -icity, yielding "kidney poisoning".