Exogenous poisonings represent a significant challenge to public health, with an alarming increase in recent years. The main causative agents include medicines, illegal drugs, household cleaning products, and pesticides. These substances can cause several nephropathies, including acute kidney injury (AKI), acute interstitial nephritis (AIN), and chronic kidney disease (CKD). Medications such as nonsteroidal anti-inflammatory drugs, acetaminophen, lithium, antiepileptics, and antidepressants, as well as pesticides such as paraquat and glyphosate, have relevant nephrotoxic effects. Drugs of abuse such as alcohol, cocaine, and opioids, as well as chemicals, including heavy metals and toxic alcohols, also have a wide range of renal toxicity mechanisms. The use of unconventional biomarkers such as NGAL, KIM-1, and IL-18 among others shows promise for early detection and intervention in cases of renal toxicity. A detailed understanding of these mechanisms is crucial for the development of effective preventive and therapeutic strategies.