Identification of groups at risk for renal diseases (including nephrotoxicity).

An assessment of the health significance of renal disease due to nephrotoxicity and identification of groups at risk for toxic nephropathy is difficult because the incidence is likely to be underestimated in the available registry data. In more than 50% of all cases of end-stage renal failure, the causality is not known. In end-stage toxic nephropathy, the kidney may show the morphological changes of chronic interstitial nephritis as well as those of chronic glomerulonephritis. Therefore, additional epidemiological data and information on exposure are necessary. Physiological, social and educational factors may aggravate exposure, and the role of multiple exposures is unknown, although individuals at risk are not only those with the highest burden of exposure. Differential sensitivity is explained in part by genetic factors, as shown for abnormal sulphoxidation and slow acetylation. Early identification of groups at risk for nephropathy of clinical significance still relies on the methods of classical nephrology, i.e., measurement of proteinuria or decreased glomerular filtration rate, but several new tests are currently under evaluation.