All areas of clinical practice · UKMLA & AKT
Drug-induced nephrotoxicity
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- Type IV (delayed) hypersensitivity reaction - drug or metabolite acts as hapten, triggering T-lymphocyte and eosinophil infiltration of the renal interstitium
- Onset typically 7-10 days after first exposure (shorter on re-exposure)
- Most common cause: penicillins (especially amoxicillin); PPIs are an increasingly recognised cause with more insidious onset
- Classic triad: fever + rash + arthralgia - present in only ~30% of cases
- More consistently found: eosinophilia, sterile pyuria, (eosinophiluria)
- Hyperkalaemia is the most common electrolyte abnormality - impaired tubular potassium excretion
Any unexplained AKI within 10 days of starting a new drug - especially a penicillin or PPI - should prompt consideration of AIN, even without the full triad.
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