Moving toward a contemporary classification of drug-induced kidney disease

Table 2 Glomerular, tubular, and interstitial damage to the kidney caused by medications

Type of damage	Examples
Glomerular/vascular
Minimal change disease	Interferon alpha & beta, Lithium
Focal segmental glomerulosclerosis	Bisphosphonates (especially pamidronate and zoledronic acid), Lithium
Membranous nephropathy	Penicillamine, Anti-tumor necrosis factor agents
Vasculitis	Hydralazine, Propylthiouracil, Allopurinol, Phenytoin, Penicillamine, Minocycline
Thrombotic microangiopathy	Gemcitabine, Bevacizumab, Interferon alpha, Ticlopidine, Clopidogrel, Oral contraceptives
Cholesterol emboli	Warfarin, Streptokinase, Alteplase
Tubular
Acute tubular injury/necrosis	Aminoglycosides, Vancomycin, Colistin, Foscarnet, Pentamidine, Tenofovir, Cisplatin, Carboplatin, Zoledronic acid
Fanconi syndrome	Tenofovir, Sodium valproate, Deferasirox
Obstructive nephropathy	Acyclovir, Sulfonamides, Methotrexate, Indinavir, Atazanavir, Triamterene, Sodium phosphate
Rhabdomyolysis	Lovastatin, Simvastatin
Tumor lysis syndrome	Cytotoxic agents, Glucocorticoids
Osmotic nephrosis	Intravenous immunoglobulin, Hydroxyethyl starch
Nephrogenic diabetes insipidus	Lithium
Nephrogenic syndrome of inappropriate antidiuresis	Carbamazepine, Haloperidol, Cyclophosphamide, Selective serotonin reuptake inhibitors
Interstitial
Acute tubulointerstitial nephritis	Beta-lactam antibiotics, Rifampin, Aminosalicylates, Proton pump inhibitors
Chronic tubulointerstitial nephritis	Lithium, Aristolochic Acid

The prevailing etiology of nephrotoxicity of these medications or medication classes is direct/indirect toxic effects on the kidney. Therefore, they mostly belong to the “damage without dysfunction” category. Notably, these medications may have more than one aspect of kidney damage. For example, apart from glomerular changes, cholesterol emboli induced by warfarin, streptokinase, or alteplase can also affect the peritubular microcirculation, leading to tubular damage. Similarly, in the case of crystal nephropathy caused by medications, both direct and indirect mechanisms are usually involved. Therefore, this table lists only some examples of medications/medication classes and should not be considered conclusive. In addition, this table does not consider medications with both damage and dysfunction features such as nonsteroidal anti-inflammatory drugs, amphotericin B, and calcineurin inhibitors

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