Arsenic and the Kidney

Arsenic is an environmental pollutant and can be found in drinking water in many countries.  Chronic exposure can cause DM, neurotoxicity, liver injury and nephrotoxicity.  Cancers of certain organs have also been found. In the past, accidental contamination of beer in England had resulted in many deaths in 1900s. The kidneys are the site for elimination of most of the arsenic concentrates.  Arsenic induced oxidative stress induces expression of HO-1 and MAPK which activate many transcription factors and eventually leading to tubular damage in the proximal component.  Kimura et al had shown that interferon gamma played a protective role in sodium arsenite induced renal injury by up regulating the intra renal multi drug resistance associated protein-1 expression. Acute tubular necrosis findings that dates back to 1900s is the commonly found renal toxicity finding. Cases of acute hemolysis related injury has been described as well.  Chronic tubular and interstitial damages have been described as well in survivors. Glomerular damage has been seen in one case. Cortical necrosis is a rare finding to begin with and rarely observed in current era, has been described in this toxin as well.  One interesting case found bilateral acute cortical necrosis, which is even a rarer event.
Isn't arsenic used as a chemotherapy agent for acute promyelocytic leukemia(APL)?  In combination with trans retinoic acid and gemtuzumab, studies have shown effective treatment of this cancer.  In the one study that showed the promise of above regimen, Grade 3 and 4 adverse events of the agents were noted.  Overall, of the 80+ patients, 4 had "renal failure" in that one study.
A toxin to the kidney that we must be at a constant watch for.