l 1 lhe kidneys are susceptible to toxic or ischemic injury for several reasons. Thus, it is not surprising that an impressive list of exogenous drugs and chemicals can cause clinical acute renal failure (ARF) [1]. On the contrary, the contribution of environmental toxins to ARF is rather limited. In this chapter, some of the most common drugs and exogenous toxins encountered by the nephrologist in clinical practice are discussed in detail.

The clinical expression of the nephrotoxicity of drugs and chemicals is highly variable and is influenced by several factors. Among these is the direct toxic effect of drugs and chemicals on a particular type of nephron cell, the pharmacologic activity of some substances and their effects on renal function, the high metabolic activity (ie, vulnerability) of particular segments of the nephron, the multiple transport systems, which can result in intracellular accumulation of drugs and chemicals, and the high intratubule concentrations with possible precipitation and crystallization of particular drugs.

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