[Drug-induced kidney disorders].

That the kidneys are vulnerable to damage by drugs is due to functional and morphological factors. Because of the high blood flow to the kidney and the high filtration fractions of the glomerular capillaries, large amounts of solutes are delivered to the tubular system. Luminal concentrations are further increased by tubular transport processes, thus exposing the tubular epithelium to high concentrations. In the medullary interstitium solute concentrations may reach high values by the counter-current multiplier system. Active enzyme systems in the kidney are capable of activating drugs into reactive toxins ("metabolic activation"). Nephrotoxic reactions due to drugs may affect each segment of the nephron, the medullary interstitium and the renal vasculature, resulting in different nephrotoxic syndromes. The drug-induced nephropathies of greatest clinical importance are reviewed and the most common nephrotoxic agents are mentioned. The underlying mechanisms of drug nephrotoxicity include a direct toxic, dose-related cellular injury or an immunologically mediated nephrotoxic drug reaction.