Final answer:
Most drug toxicities that cause ATN occur in the kidneys and can result from various substances, including NSAIDs, antibiotics, iodinated contrast, and ethylene glycol. These substances cause direct or indirect damage to the tubular cells of the kidneys, which can lead to acute tubular necrosis.
Step-by-step explanation:
Acute Tubular Necrosis (ATN) is a condition where the tubular cells of the kidneys are damaged. This damage can be caused by toxins or medications that have a direct or indirect effect on the kidney tissues. Some common culprits of drug-induced ATN include NSAIDs, aminoglycoside antibiotics, iodinated contrast agents, and lithium. Rhabdomyolysis is another cause of ATN, where myoglobin released from muscle breakdown affects the kidneys; this can be due to trauma, statins, or stimulants. Ethylene glycol toxicity occurs 24 to 72 hours post ingestion, as glycolic acid—formed from its metabolism—is directly cytotoxic to kidney cells and eventually forms oxalic acid that binds with calcium in the kidneys.
Other substances like arsenic disturb biochemical processes like oxidative phosphorylation, leading to effects on organ function such as mucus dehydration analogous to cystic fibrosis. Arsine can cause intravascular hemolysis leading to renal failure, while cyanide prevents cellular oxygen utilization, causing metabolic acidosis. Finally, botulinum toxin (BoNT) can cause intoxications through contaminated food or inhalation, potentially leading to serious systemic effects.