Investigators in the 1960s found that patients with poor kidney function were predisposed to various adverse drug reactions. Research demonstrated that impaired kidney function affects not only clearance but also absorption, distribution, metabolism and non-renal-clearance of drugs: these aspects represents the pharmacokinetic (PK) of drugs and the basic rules was written by Calvin Kunin and Luzius Dettli. To determinate the right dose of drugs doesn’t depend only by PK, but also by the pharmacodynamics (PD) that represents the effect that drug achieve; the therapeutically effective range of a drug depends on its Hill coefficient. To provide precision in pharmacotherapy, near PK and PD, there is pharmacogenomics that tests for genetic variation in genes that are responsible for drug metabolism, transport and target of drug action and can be used to select the best medication or aid in dosing. To better study the drug toxicity, the PK and physiology of kidney, there are novel technology in the field of engineering which provides new options like kidney-on-a-chip that mimic organ level functions and disease to replace some traditional animal and human studies.