Nephrotoxicity
Drug-induced kidney damage. Since many peptides are cleared by the kidneys, renal function affects peptide drug levels and dosing. Certain antimicrobial peptides (colistin, polymyxin B, vancomycin) have well-known nephrotoxic potential requiring careful dose adjustment and monitoring of kidney function.
Technical Context
Nephrotoxicity is assessed by monitoring serum creatinine, blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR). Acute kidney injury (AKI) is classified by KDIGO criteria based on creatinine elevation or urine output reduction. Antimicrobial peptides with significant nephrotoxic potential: colistin/polymyxin B (dose-dependent proximal tubular necrosis — incidence 20-60% depending on dose and duration, requiring careful dose adjustment and monitoring), vancomycin (acute interstitial nephritis and/or acute tubular necrosis — trough monitoring targets 15-20 μg/mL for serious infections to balance efficacy vs nephrotoxicity). For GLP-1 RAs, initial reports of acute kidney injury prompted FDA warnings, though the mechanism appears related to dehydration from GI side effects (nausea, vomiting, diarrhoea) rather than direct nephrotoxicity. Adequate hydration counselling is important during GLP-1 RA initiation.