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Toxic Responses To The Kidney
Toxic Responses To The Kidney
Uninjured Cells
Injured Cells
Cell death
Compensatory Hypertrophy
Cellular adaptation
Cellular Prolifertation
Cellular Repair
Re-epithilization
Cellular adaptation
Differentiation
2. Vasoconstriction Nonsteroidal anti-inflammatory drugs Radiocontrast agents Cyclosporine Amphotericin B 3. Crystalluria Sulfonamides Methothrexate Acyclovir Triamterene Ethylene glycol Protease inhibitors
4. Tubular Toxicity Aminoglycosides Cisplatin Vancomycin Pentamidine Radiocontrast agents Heavy metals Haloalkane and haloalkene cyssteine conjugates
5. Endothelial Injury Cyclosporine Mitomycin Cocaine Conjugated estrogens Quinine 6. Glumerulopathy Gold Penicillamine NSAIDS
Specific Nephrotoxicants
1. Heavy metals
a. Mercury-HgCl2 ,affects proximal tubules b. Cadmium-causes proximal tubule dysfunction and injury
2. Halogenated Hydrocarbons
a. Chloroform-glomrulus or the distal tubule b. Tetrafluoroethylene-proximal tubule c. Bromobenzene-
3. Mycotoxins-increased urine volume, decreased osmolality, and increased excretion of low and high molecular weight proteins 4. Therapeutic Agents
a. Acetaminophen-proximal tubular necrosis with increase in BUN and plasma creatinine, decreases GFR b. Non-steroidal Anti-inflammatory Drugs
5. Aminoglycosides
a. Amphotericin B b. Cyclosporine c. Cisplatin
6. Radio-contrast Agents