The regionally specific structure and function of the kidney renders it susceptible to toxic exposure. To characterize these changes at the proteome level, we have investigated the effects on protein expression following treatment with gentamicin. The more than 20 proteins identified were involved in the citric acid cycle, gluconeogenesis, fatty acid synthesis, and transport or cellular stress responses. These results strongly support the notion that energy production is impaired and mitochondrial dysfunction is involved in gentamicin-induced nephrotoxicity.