الفهرس 
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Abstract
In addition to its role in water and electrolyte homeostasis, the
kidney is the primary organ for excretion of drugs and their metabolites
from the body. There are three basic processes involved in renal drug
excretion: glomerular filtration, tubular secretion, and tubular reabsorption.
Most drugs found to cause nephrotoxicity exert toxic effects by one
or more common pathogenic mechanisms. These include altered intra
glomerular hemodynamics, tubular cell toxicity, inflammation, crystal
nephropathy, rhabdomyolysis, and thrombotic micro-angiopathy.
Knowledge of offending drugs and their particular pathogenic
mechanisms of renal injury is critical to recognizing and preventing drug
induced renal impairment.
Drugs cause approximately 20 percent of community and hospital
acquired episodes of acute renal failure.
Among older adults, the incidence of drug-induced nephrotoxicity
may be as high as 66 percent.
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Summary and Conclusion
Some patient related risk factors for drug induced nephrotoxicity
are age older than 60 years, underlying renal insufficiency (e.g., glomerular
filtration rate of less than 60 mL per minute per 1.73 m2), volume
depletion, diabetes, heart failure, and sepsis. General preventive measures
include using alternative non nephrotoxic drugs whenever possible;
correcting risk factors, if possible; assessing baseline renal function before
initiation of therapy, followed by adjusting the dosage; monitoring renal
function and vital signs during therapy; and avoiding nephrotoxic drug
combinations.