Toxin-Related Acute Kidney Injury

Clinical Background: Nephrotoxic acute kidney injury or toxin-related acute kidney injury (ToxAKI) is a relevant and relatively common category of kidney damage. Exogenous toxins and venomous animals with epidemiologic variations across the world are some nephrotoxic agents. Epidemiology: The epidemiologic features of the toxic agent-related acute kidney injury are associated with different culture, biodiversity of the tropics, and economic status. It seems economic status is the major factor which defines the etiology of ToxAKI. In developing countries, the AKI is commonly associated with self-poisonings by pesticides and herbicides, while developed countries often notify poisonings due to antibiotics, nonsteroidal anti-inflammatory drugs, immunosuppressants (such as methotrexate), and iodinated contrast media. Moreover, envenoming due to snakes, spiders, and scorpions is more frequent in tropical regions. Challenge: Poisoned patients are more susceptible to renal impairment associated with renal replacement therapy and death. Prevention and Treatment: Preventing patient exposure and performing early diagnosis are crucial to beat the main causes of ToxAKI and further complications. Renal replacement therapy may be necessary to manage the patient, and it is associated with poor prognosis and death. According to each poisoning profile, specific measures are suggested. School-base interventions, early identification, treatment, and care of people with mental and substance use disorders, reducing access to chemical agents, making parents aware of the hazards of accidental poisoning in children, and maintaining fully functional poison control centers are vital actions too.