The kidneys are highly susceptible to injury from drugs and toxins. The glomerular blood vessels have a large endothelial surface for contact with drugs and drugs may be concentrated in tubular fluid by the normal reabsorption of water from the tubules.
Many drugs have the potential to produce nephrotoxicity.
Toxins include arsenicals, mercury, thallium, turpentine, lead, and ethylene glycol. Normal kidneys can excrete hemoglobin and myoglobin without damage but in the face of concurrent dehydration, nephrotoxicity and ARF may occur. Pre-existing renal disease or dehydration may enhance the effects of toxins. Renal lesions may be reversible in days to weeks or irreversible. Drugs which are renally excreted need to have the dose or dose interval altered to prevent accumulation of toxic levels of the drug in patients with renal disease.