Nephrotoxicity is frequently seen with many common medications in use today. This is not surprising given the renal bed's significant exposure to administered medication, as it receives 25% of the resting cardiac output over a large endothelial surface area. With a high metabolic rate involving numerous enzymes and transtubular cell transport processes, renal glomerular, tubular, and interstitial cells may come in contact with drugs and their metabolites at greater concentrations than expected. Some medications can affect the vasoregulatory mechanisms of the kidney to cause a functional limitation. Nephropathy is often recognized only when filtration is affected, as seen by a rise in the blood urea nitrogen (BUN) and serum creatinine, because there are as yet no good serologic markers to determine the subtle insults to the kidneys. In a 1-year survey involving 55 centers, the Societe de Nephrologie identified 18.3% of acute renal failure (ARF) cases as drug-related. These cases were diagnosed as either acute tubular necrosis (ATN) or acute interstitial nephritis (AIN).<sup>34 Kleinknecht D., Landais P., Goldfarb B. Drug associated acute renal failure: A prospective multicenter report Proc EDTA-ERA 1988 ;  22 : 1002

Cliccare qui per andare alla sezione Riferimenti</sup> The true incidence of drug-induced nephropathy is difficult to establish because the clinicopathologic presentation can be quite varied. Medications can cause ARF by varieties of mechanisms, which include decreased renal perfusion, vascular or direct tubular injury, allergic interstitial inflammation, and glomerular basement membrane injury. Medications can also cause chronic renal failure with chronic interstitial injury and papillary necrosis. Subtle changes occurring as a result of tubulopathy early on, such as electrolyte imbalances, acid-base abnormalities, disorders of water balance, and other urinary sediment abnormalities, are often not perceived as drug induced and can progress to significant morbidity. This article discusses each of these specific clinicopathologic presentations in relation to current commonly used drugs or classes of drugs, so that as newer similar medications are developed, awareness of possible toxicity is heightened.