Where does nephrotoxicity occur for gentamicin?

Gentamicin, an aminoglycoside antibiotic, is primarily associated with nephrotoxicity that occurs in the proximal tubule of the nephron. This occurs because gentamicin undergoes significant renal uptake and is concentrated within renal tubular epithelial cells, particularly in the proximal tubules.

In these cells, gentamicin can disrupt cellular function, leading to a cascade of effects, including the generation of reactive oxygen species and impaired cellular transport mechanisms. As the proximal tubule is crucial for the reabsorption of water, electrolytes, and other solutes, damage to these cells can result in acute kidney injury characterized by tubular dysfunction.

The other parts of the nephron, such as the distal convoluted tubule, glomerulus, and Loop of Henle, are less commonly associated with the nephrotoxic effects of gentamicin, which is why the proximal tubule is recognized as the primary site of gentamicin-induced nephrotoxicity. Understanding this mechanism is important for monitoring and managing potential renal side effects during gentamicin therapy.