The kidney's many unique features render it susceptible to toxicity. Circulating agents are thus delivered at 50 times the rate as for other tissues. Distribution disorders can accelerate toxicity, eg, through constriction of a major vascular bed. Thus, a disproportionate sample of absorbed agents is presented to the kidney via arterial circulation. The surface area exposed is enormous because of a fine brush border on proximal tubular cells.
Tubular transport separates drugs from binding proteins, which commonly protect other cells.
Transcellular transport exposes the interior of the cell and its organelles to newly encountered chemicals. As the leading site of immune complex deposition, the kidney is uniquely susceptible to immunologic injury. The mesangium is a site for invasion of monocytes, phagocytes, and other biologically active cells migrating from the blood. Antioxidants have been proposed to treat oxidant damage to the kidneys. HCO 3 infusions for acidosis due to the production of formic acid may also be indicated.