International Journal of Molecular Sciences Review The Mechanism of Drug Nephrotoxicity and the Methods for Preventing Kidney Damage Ewa Kwiatkowska 1,* , Leszek Doma ´nski 1, Violetta Dziedziejko 2 , Anna Kajdy 3, Katarzyna Stefa ´nska 4 and Sebastian Kwiatkowski 5 1 Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland;
[email protected] 2 Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland;
[email protected] 3 Centre of Postgraduate Medical Education, Department of Reproductive Health, St. Sophie’s Obstetrics and Gynecology Hospital, 01-004 Warsaw, Poland;
[email protected] 4 Department of Obstetrics Medical, University of Gda´nsk,80-952 Gda´nsk,Poland;
[email protected] 5 Department of Obstetrics and Gynecology, Pomeranian Medical University, 70-111 Szczecin, Poland;
[email protected] * Correspondence:
[email protected]; Tel.: +48-91-466-1196 Abstract: Acute kidney injury (AKI) is a global health challenge of vast proportions, as approx. 13.3% of people worldwide are affected annually. The pathophysiology of AKI is very complex, but its main causes are sepsis, ischemia, and nephrotoxicity. Nephrotoxicity is mainly associated with the use of drugs. Drug-induced AKI accounts for 19–26% of all hospitalized cases. Drug-induced nephrotoxicity develops according to one of the three mechanisms: (1) proximal tubular injury and acute tubular Citation: Kwiatkowska, E.; necrosis (ATN) (a dose-dependent mechanism), where the cause is related to apical contact with Doma´nski,L.; Dziedziejko, V.; Kajdy, drugs or their metabolites, the transport of drugs and their metabolites from the apical surface, and A.; Stefa´nska,K.; Kwiatkowski, S.