Introduction

Nephrotoxicity is a feature of many chemicals [1, 2], which find widespread use in industry and it is also a feature of a wide variety of drugs; particularly important are the heavy metals, hydrocarbons and solvents as well as insecticides, herbicides and fungicides (Table 7.1). Many important drugs are nephrotoxic, including antibiotics, immunosuppressive agents and some anticancer drugs together with non-prescription drugs including nonsteroidal anti-inflammatory drugs. Although nephrotoxicity does not preclude their use, it is important that it is recognized, the exposure minimized and the effects monitored. Initially, a nephrotoxin will affect a discrete region or cell type in the nephron, some initially attacking the glomerular cells, e.g. hydrocarbons and some solvents, while others affect the tubules, e.g. antibiotics. The kidney is particularly susceptible to circulating toxins because of its high blood flow, its ability to concentrate chemicals in the tubular fluid prior to tubular absorption, transcellular transport which results in maximal exposure of the cells to the active metabolic systems present in the tubular cells and because many chemicals can induce an immune response by the kidney. Changes in kidney structure and function are reflected in the profile of excretory products in urine; changes in serum profiles normally occur late in the damage process and are, therefore, not good markers of renal damage. Biomarkers can be divided broadly into three types for diagnostic purposes.