All areas of clinical practice · UKMLA & AKT
Drug-induced nephrotoxicity
A free high-yield preview for the UKMLA Applied Knowledge Test. Below are the key points to recognise drug-induced nephrotoxicity — the full SA Note notes add investigations, management, complications and 10 practice questions.
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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