Drug-related nephrotoxicity
Description
- ~20% of hospital-acquired AKI is drug-related and most is preventable
- Classify by site and mechanism - that is what determines the urine findings and the treatment
| Site | Lesion | Urine |
|---|---|---|
| Pre-glomerular | Haemodynamic (afferent/efferent tone) | Bland, low FENa |
| Glomerulus | MCD, FSGS, membranous, TMA | Proteinuria +/- haematuria |
| Tubule | ATN, crystal, osmotic, tubulopathy | Muddy brown casts, crystals, glycosuria |
| Interstitium | AIN, chronic interstitial nephritis | Sterile pyuria, WCC casts |
| Post-renal | Crystal obstruction, retroperitoneal fibrosis | Obstruction on US |
- *Always ask: is this a real fall in GFR, or an interference?*
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