Acute toxic kidney injury

Abstract

Substances toxic to the kidney are legion in the modern world. The sheer number and variety, their mutual interactions and, metabolism within the body are a challenge to research. Moreover, the kidney is especially prone to injury owing to its physiology. Acute kidney injury (AKI) induced by poisonous or primarily nephrotoxic substances, may be community acquired with ingestion or inhalation or nosocomial. Many nephrotoxic plants, animal poisons, medications, chemicals and illicit drugs can induce AKI by varying pathophysiological pathways. Moreover, the epidemiology of toxic AKI varies depending on country, regions within countries, socioeconomic status and health care facilities. In this review, we have selected nephrotoxic insults due to medication, plants, animal including snake venom toxicity, environmental, (agri)chemicals and also illicit drugs. We conclude with a section on diagnosis, clinical presentation and management of poisoning accompanied by various organ dysfunction and AKI.

Keywords: acute kidney injury; drug nephrotoxicity; illicit drug nephrotoxicity; plant nehrotoxicity; renal biomarkers; toxic nephropathy.

Figure 1.

Drug-induced nephrotoxicity – cellular mechanisms [12–23].

Figure 2.

Pathophysiology of plants-induced nephrotoxicity [37,38,53–58].

Figure 3.

The mechanisms of selected environmental and (agri)chemical nephrotoxicity [69–82].

Figure 4.

Mechanisms of illicit drug nephrotoxicity [92–104].