Gentamicin (GM) is a widely used antibiotic but shows renal toxicity. We produced a serum against GM (anti-GM) conjugated to bovine serum albumin with N-(gamma-maleimidobutyryloxy)succinimide. The antiserum was monospecific for GM and did not cross-react with the analog streptomycin, tobramycin, kanamycin, or amikacin. The antiserum also detected glutaraldehyde-fixed GM, and this enabled us to develop an immunocytochemical method for detecting the uptake of GM in rat kidney. Twelve hours after a single intravenous administration of GM, immunocytochemistry revealed that GM accumulated in the S1, S2, and S3 segments of the proximal tubules, as well as in the distal tubules and collecting ducts. By 12 h after injection, the drug was detected in cytoplasmic granules of the proximal tubule cells. However, early (1 h) after injection, drug accumulation was detected in the microvilli of these cells. The distal tubules and collecting ducts contained scattered swollen cells, reminiscent of necrotic cells, in which both the nuclei and the cytoplasm reacted strongly with GM. No staining occurred in the kidneys of saline-injected control rats. These results agree with previous studies showing that GM is endocytosed in the proximal tubules and accumulates in lysosomes. Additionally, our results show that GM also accumulates in the distal tubules and collecting ducts. This was achieved by systematically varying the pretreatment conditions-an approach necessary for detecting GM in different subcellular compartments. This approach should be useful for accurately detecting the uptake and toxicity of the antibiotic in different tissues.Gentamicin (GM) is widely used as a bactericidal agent for the treatment of severe infections with gram-negative bacteria, such as Pseudomonas aeruginosa. Its antibacterial activity is due to an irreversible inhibition of bacterial protein synthesis. However, clinical use of aminoglycosides, such as GM, is limited by their ototoxicity and nephrotoxicity. The mechanisms behind the nephrotoxity have been investigated extensively, but how these drugs induce cellular malfunction and necrosis remains to be elucidated. Accurate localization of GM in cells and tissues can be expected to contribute to this effort. Previously, subcellular fractionation (27), micropuncture techniques (24), and autoradiography using radioactively labeled aminoglycosides (6, 26) have been used to study the mechanisms of nephrotoxity. Additionally, immunogold labeling methods have been used to study the subcellular distribution of aminoglycosides in proximal tubules of the nephron (1,2, 3,4,20). However, these studies have been limited to ultrastructural analysis of proximal tubule cells. Recently, we have successfully developed immunocytochemical (ICC) procedures for detecting the cellular uptake of other water-diffusible small-molecule drugs, such as daunomycin (DM) (14,15,22,23). These procedures make use of glutaraldehyde (GA)-fixed tissues, which undergo a series of pretreatments to unmask sites of accumulation of the drug...