Mechanisms of antibiotic-induced nephrotoxicity.

Each of the major classes of clinically useful antibiotics can cause neph­ rotoxicity. Major differences exist among classes, and these are reviewed with regard to the frequency of occurrence of nephrotoxicity, the direct or indirect toxic effects of the drugs, their site(s) of action within the kidney, current views of their pathophysiological effects and observations which provide clues to the biochemical mechanisms underlying their adverse effects on kidney structure and function. Even for a single abnormal kidney function, such as non-oliguric reduction of glomerular filtration rate by gentamicin, the physiological and biochemical mechanisms may be com­ plex. In no instance has the biochemical mechanism underlying antibioticinduced nephrotoxicity been definitely established.