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GEORGE A. PORTER information is an international commodity whose The field of clinical nephrotoxicity involves toxins of interpretation and application are strongly influenced diverse origin and exposure. A significant contribution by both the cultural and ethnic background of the to this problem arises from registered and non-regis­ observer. The opportunity to share in the rich diversity tered drugs either prescribed or purchased over the of the international scientific community was a fun­ counter. Another major contributor comes from occu­ pational or industrial exposures. Each situation pre­ damental goal of this endeavor. To participate as sents the nephrologist with unique challenges con­ equals leads to mutual respect and peer appreciation. cerning diagnosis, confirrnation, and treatment includ­ The sharing of intellectual resources which such an ing limitation from future exposure. In selecting drugs effort fosters, should facilitate the advancement of for inclusions in this book the editors were guided by sound science. both frequency and current knowledge. For occupa­ Our approach to the field of nephrotoxicity is from tionall environmental exposures similar guidelines the perspective of a book which will be of value to the were applied. As one reviews the world's literature clinician. In this respect we have chosen compounds concerning nephrotoxicity two types of investigation wh ich are of current importance to the nephrologist and his/her patient rather than of historical interest.

The majority of the offending toxicants to be reviewed in this volume were devel­ oped to help mankind, and it is only with prolonged or widespread application that their adverse effects have been recognized. Conversely, in the case of pre scrip­ tion drugs, there has been an attempt to identify the adverse effects in advance and incorporate these risks into the decision of approval for human consumption. Unfortunately, for those drugs in which recognized injury occurs only after prolonged use, such appraisals are made in retrospect. Despite this, most renal injury induced by drugs or toxicants can be either prevented by excluding drugs with unacceptable side effects or interrupted by eliminating the offending agent once damage is manifested. The fact that prevention, reversibility, or arrest of renal injury is possible provided a major impetus for this publication. Since no international registry for nephrotoxic injury exists, estimates of incidence must rely on less than ideal sources. Recently I, together with Dr. William Bennett, summarized a survey of the frequency of various categories of nephrologic disease (Porter and Bennett, 1981). Based on this survey, we projected that in nearly one of ten patients seeking nephrologic consultation a nephrotoxic etiology may be involved. Of cases of end-stage renal disease, between 3 and 4% are due to drug nephrotoxicity, according to recent published results(European Dialysis and Transplant Association, 1979). For acute renal failure, antibiotics and contrast agents persist as major offending agents, while for chronic renal failure, analgesics remain a worldwide problem.

Clinical Nephrotoxins: Renal Injury from Drugs and Chemicals, Third Edition is a comprehensive text on all aspects of adverse effects by drugs, chemical substances and radiation on the kidneys. The importance of the toxicity of drugs and other substances for the kidneys is increasingly recognized. The book consists of themes such as clinical relevance, renal handling and cellular mechanisms of nephrotoxicity, as well as animal and cell culture models. In addition, the volume highlights specific types of drugs, such as anti-infectious agents and anti-inflammatory, cardiovascular and anti-cancer drugs. The last section deals with prevention and focuses on urinary biomarkers, pharmacological aspects and drug dosage in renal failure. In this third and completely revised edition, several new topics were added and additional figures and tables will be included. The book is of interest for the nephrologist, internist, general practitioner, toxicologist, pharmacologist, anesthesiologist, epidemiologist, public health official, pharmaceutical industry, and national drug safety committees, among others.

To you the reader, the joy of discovery begins, for We continue in our goal of providing a text which us the job is done. In this edition, we have corrected is useful, not only to the clinician, but of equal interest past deficiencies, added new topics, expanded infor- to the investigator. The selection of content has been mation regarding the pediatric age group, provided directed at topics of current interest rather than those up to date (March 2003) references, while remaining of historic contribution. We have stressed the cont- true to our concept of a multi-national author book. bution of cell biology and pathophysiology, were it We continue to believe that scientific information is an exists, believing it provides both a better understa- international commodity whose interpretation and ap- ing of toxic injury when known, and a rational dir- plication are strongly influenced by both the cultural tion for therapy and prevention. and ethnic background of the observer. The oppor- nity to share in the rich diversity of the international We are encouraged by the accumulation of rec- scientific community remains a fundamental goal of nized risk factors, which allow pre-treatment strati- this endeavor. To participate as equals leads to mu- cation of our patients'relative risk and allow us to - tual respect and peer appreciation. The sharing of in- cus our preventative techniques on the individuals tellectual resources fostered by this effort should and most likely to gain the greatest benefit.