Figure 8-18 Proposed pathway for the metabolic activation of compound A shows formation of an intrahepatic glutathione (GSH) conjugate of compound A that is translocated to the kidney, where γ-glutamyl transpeptidase, cysteinylglycine dipeptidase, and renal cysteine conjugate β-lyase catalyze the formation of a nephrotoxic thiol, which can acylate kidney proteins. (Adapted from Martin JL, Kandel L, Laster MJ, et al: Studies of the mechanism of nephrotoxicity of compound A in rats. J Anesth 11:32–37, 1997.)