The kidneys are the primary site of aminoglycoside clearance; any factor that permits renal parenchymal accumulation increases the risk of aminoglycoside nephrotoxicity. The most common underlying cause is excessive aminoglycoside administration (especially in women or elderly patients). To minimize the risk of nephrotoxicity, select loading and maintenance aminoglycoside dosages based on estimated creatinine clearance. Also, monitor peak and trough serum aminoglycoside levels, replenish volume, and correct potassium and magnesium abnormalities. If possible, avoid giving aminoglycosides to patients with hepatic dysfunction or to those receiving other nephrotoxic drugs or radiocontrast agents.