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AKI Nephrotoxic Drug Review — FRCA Final MCQ

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ModeratePerioperative MedicineAKI Nephrotoxic Drug ReviewFRCA Final

A 55-year-old man (ASA III) develops postoperative acute kidney injury stage 2 (KDIGO) after major vascular surgery. His serum creatinine has risen to 280 μmol/L from a baseline of 95. According to NICE NG148, which nephrotoxic drugs should be reviewed and potentially withheld?

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Correct answer: B — ACE inhibitors, ARBs, NSAIDs, aminoglycosides, and metformin

NICE NG148 recommends reviewing and considering stopping all potentially nephrotoxic drugs in AKI. Key drugs to review include: ACE inhibitors and ARBs (reduce GFR), NSAIDs (reduce renal perfusion), aminoglycosides (direct tubular toxicity), metformin (risk of lactic acidosis with reduced clearance), diuretics (may worsen dehydration), and contrast media. Volume status should be optimised, and renal function monitored closely. Paracetamol is safe in AKI and is not nephrotoxic.

Reference: NICE – 2019 – NG148 Acute kidney injury; RCOA – 2023 – Perioperative medicine