Kidney damage caused by antibiotics is a common occurrence. In hospital wards it accounts for approximately 10% of episodes of acute renal failure and 60% of drug-related kidney damage. At greatest risk are elderly patients, especially those with preexisting chronic renal failure or comorbidities, suffering from dehydration, or hospitalized in intensive care units. The kidney's marked susceptibility to this type of damage is due to various factors including the high concentration of the toxic agent and the elevated blood flow in the kidney, and the relatively hypoxic environment. Kidney damage from antibiotics is characterized by different pathogenetic mechanisms and all kidney structures may be affected, resulting in different clinical syndromes. It is therefore of paramount importance to identify those antibiotics which have potential nephrotoxic effects so that their dosage can be based on the patient's renal function and all factors that may potentiate the toxicity can be corrected.