Antiviral drug-induced nephrotoxicity

Am J Kidney Dis. 2005 May;45(5):804-17. doi: 10.1053/j.ajkd.2005.02.010.


Drug-induced kidney injury is a major side effect in clinical practice, frequently leading to acute renal failure (ARF). It accounts for more than 2% to 15% of cases of ARF in patients admitted to the hospital or in the intensive care unit, respectively. The exact frequency of nephrotoxicity induced by antiviral drugs is difficult to determine. Antiviral drugs cause renal failure through a variety of mechanisms. Direct renal tubular toxicity has been described with a number of new medications with unique effects on epithelial cells of the kidney. These include cidofovir, adefovir dipivoxil, and tenofovir, as well as acyclovir. Additionally, crystal deposition in the kidney may promote the development of renal failure. Several different drugs have been described to induce crystal nephropathy, including acyclovir and the protease inhibitor indinavir. Renal injury associated with antiviral drugs involves diverse processes having effects on the renal transporters, as well as on tubule cells. In this article, we review the pathogenesis of antiviral drug-induced kidney injury, common nephrotoxic renal syndromes, and strategies for preventing kidney injury.

Publication types

  • Review

MeSH terms

  • Acidosis, Renal Tubular / chemically induced
  • Acute Kidney Injury / chemically induced
  • Acute Kidney Injury / prevention & control
  • Anti-HIV Agents / adverse effects
  • Antiviral Agents / adverse effects*
  • Antiviral Agents / pharmacology
  • Biological Transport / drug effects
  • Crystallization
  • Diabetes Insipidus, Nephrogenic / chemically induced
  • Epithelial Cells / drug effects
  • Humans
  • Kidney / drug effects*
  • Kidney Diseases / chemically induced*
  • Kidney Diseases / prevention & control
  • Kidney Tubules / drug effects
  • Risk Factors


  • Anti-HIV Agents
  • Antiviral Agents