Drug-related nephrotoxicity
Drug causes of kidney injury sorted by mechanism (haemodynamic, tubular, interstitial, crystal, glomerular), the high-yield culprits, and how to prevent and recognise each.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Drugs contribute to about 1 in 5 cases of AKI in hospital, and more in older people.
- Sort culprits by mechanism: haemodynamic, tubular toxicity, interstitial nephritis, crystal nephropathy, glomerular injury and thrombotic microangiopathy. The mechanism predicts the urine findings and the prognosis.
- Risk rises with CKD, older age, volume depletion, heart failure, cirrhosis, diabetes, and combinations of nephrotoxins.
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Sources
- Kidney and Urinary (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Chronic Kidney Disease (CKD) Management in Primary Care, 5th editionAU/NZKidney Health Australia, 2024
- KDIGO Clinical Practice Guideline for Acute Kidney Injury (Kidney International Supplements 2012;2:1-138)Kidney Disease Improving Global Outcomes, 2012 (2026 AKI/AKD update: public review completed, final not yet published)
- Rybak MJ et al. Therapeutic monitoring of vancomycin for serious MRSA infections: a revised consensus guideline (ASHP, IDSA, PIDS, SIDP). Am J Health Syst Pharm 2020;77:835-64American Society of Health-System Pharmacists, 2020
- Davenport MS et al. Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology 2020;294:660-8Radiology, 2020
- Weisbord SD et al. Outcomes after angiography with sodium bicarbonate and acetylcysteine (PRESERVE). N Engl J Med 2018;378:603-14New England Journal of Medicine, 2018
- Last updated
- 14 November 2026
What changed
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