Nephrotoxicity of anti-infective drugs in intensive care unit: an update

Abstract

In intensive care unit, drugs are responsible of 25% of acute kidney injury [1], and among them, anti-infectious are oftenly concerned. Renal tubule, at the crossroads of drug excretion after glomerular filtration, play a major role in this pathogenesis. Targeted in this decisive square, proximal convoluted tubule (PCT) can be affected directly on its apical or basolateral pole, or undirectly after hemolysis and rhabdomyolysis. Drug accumulation in the tubule’s lumen can also interrupt urinary flow, forming cristals or aggregates. Allergic reaction can occur triggering T cells activation thus interstitial infiltration leading to kidney injury. Finally, some drugs are responsible for an inhibition of the tubular secretion, without any loss of glomerular filtration.