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BOOK REVIEW

Clinical Nephrotoxins: Renal Injury From Drugs and Chemicals(Second Edition)

Editors: Marc E. De Broe, George A. Porter, William M. Bennett, and Gert A. Verpooten

Publisher: Kluwer Academic Publishers

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RUG-INDUCED nephropathy is of greatgeneral interest given the ever-growing num-

er of medications, including herbal, that patientsre taking. Also, it has become apparent that therere several environmental and industrial toxins thatan cause nephropathy. Clinical Nephrotoxins: Re-al Injury From Drugs and Chemicals is a hard-over book that explores the mechanisms by whichedications, environmental toxins, and industrial

oxins can cause renal disease. The book is a12-page, 35-chapter work, written by 95 interna-ional authors.

The first 7 chapters serve as the foundation forhe remainder of the book. Among the topics dis-ussed are the renal handling of medications andther foreign materials (environmental toxins, etc),echanisms of renal injury at a cellular level,

mmune-mediated renal injury by toxins, and theirlinical importance. These chapters go a long wayn enhancing our understanding of how the kidneyandles medications and toxins. The general patho-hysiology behind renal injury is also exploredithin the book, and this review is quite good.The bulk of the book covers specific medica-

ions, environmental toxins, and industrial toxinshat are known to cause renal injury. Importantly,he medications and toxins reviewed are of current,nd not historical, clinical interest. Medicationseviewed include several antibiotics, antivirals, anti-nflammatory agents and analgesics, antihyperten-ives, immunosuppressives, radiocontrast agents,nd many others. I was also happy to see herbalroducts, specifically aristolochic acids, includedn the book. Obviously, with the greatly increasednterest in Eastern medicine, this cause of renalailure will only become more problematic. Balkanndemic nephropathy is discussed, and toxins within

© 2003 by the National Kidney Foundation, Inc.0272-6386/03/4206-0033$30.00/0doi:10.1053/j.ajkd.2003.09.007

American Journal of324

he African continent, hair dye, mercury, and pesti-ides are among the environmental and industrialoxins reviewed.

The final few chapters focus on the prevention ofrug- and toxin-induced nephropathy. Most of thendividual chapters address the prevention of theephropathy caused by the specific medication oroxin involved. However, the final chapters addressrevention in a more global way. Urinary biomark-rs of nephropathy are addressed in one chapter.nother chapter focuses on the pharmacokinetics

nd pharmacodynamics of medications in renalailure, as well as drug interactions. The final chap-er lists proposed medication dosing regimens,hich may have been more useful if the proposed

egimens had been referenced.Most chapters have contributions from multiple

uthors and provide very good, up-to-date informa-ion and a very thorough reference list. Most of thehapters flow very well, often commenting (whenpplicable) on clinical manifestations, pathology,athophysiology of renal injury (known or sus-ected), and preventive measures. However, I willay that a couple of chapters did not follow thisorm, and I was slightly disappointed with thesehapters. All chapters have figures and tables, includ-ng pictures of biopsies, when applicable. I found thegures and tables to be quite helpful and aided in mynderstanding of the topic being presented.

Overall, this book provides a very good over-iew on the mechanisms of drug- and toxin-inducedephropathy. Up-to-date information on current clini-ally relevant medications (including herbal) andorldwide environmental and industrial toxins is pro-ided. It would be a welcome addition to any healthare provider’s collection of reference books.

Bhavin Patel, PharmDNephrology Clinical Pharmacy Specialist

Hennepin County Medical CenterMinneapolis, Minnesota

Kidney Diseases, Vol 42, No 6 (December), 2003: p 1324