The kidney--the body's playground for drugs: an overview of renal drug handling with selected clinical correlates.

TL;DRAbstract

A greater understanding of transport mechanisms contributing to renal drug handling may be useful in predicting drug clearance and drug interactions. Renal clearance is a dynamic process expressed as the sum of the rates of glomerular filtration and tubular secretion minus the rate of tubular reabsorption. Because the transport of drugs is often against a concentration gradient, renal secretion is mostly an active process involving a variety of transporter mechanisms. Discoveries from molecular biology techniques and gene 'knock-out' experiments have identified a variety of renal tubular proteins responsible for the transport of organic cations, organic anions, neutral and cationic hydrophobic compounds, anionic conjugates and specific agents such as prostaglandins. The discovery of a P-glycoprotein (P-gp) transporter at the apical membrane of renal tubular cells is particularly important. By elucidating compounds that act as substrates, inhibitors or inducers of transport proteins, ph

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