Drug-Induced Nephrotoxicity: Biomarker-Based Phytotherapeutic Interventions

Drug-induced nephrotoxicity (DIN) is a frequent and serious complication associated with antibacterial, antiviral, anticancer, antifungal and several other commonly used medications, such as painkillers and antacids. A literature survey was conducted on DIN, its biomarkers, phytotherapy and mechanisms in PubMed, Scopus and Web of Science from 2000 to 2025. It distinguished between preclinical studies and available clinical evidence. The drugs can damage renal cells through diverse mechanisms, resulting in both acute and chronic kidney injury. The consequent dysregulation of key biomarkers, such as serum creatinine, urea and kidney injury molecule-1, hinders early detection and complicates clinical management. A clearer understanding of these biomarkers is critical for improving diagnostic precision and developing targeted therapeutic strategies. Current treatment approaches for DIN are largely limited to discontinuing the offending drug, dose reduction or supportive care, all of which provide only partial benefit. This underscores the need for safer and more effective interventions. Phytochemicals and other natural compounds are increasingly recognised for showing promising nephroprotective effects in preclinical studies owing to their broad pharmacological activities and relatively low toxicity. The review summarises the role of bioactive agents in modulating multiple pathways, including apoptosis, oxidative stress and inflammation, while also enhancing endogenous antioxidant defences, promoting cellular repair and preserving renal function. Advancing knowledge of the molecular mechanisms underlying phytochemical-mediated renoprotection and their roles in biomarker-mediated therapeutics may facilitate the development of innovative therapeutic and preventive approaches. Such strategies hold the potential to move beyond symptomatic management, offering improved outcomes and better quality of life for patients at risk of DIN.