Drug-associated acute tubular injury — ESENeph MCQ

Correct answer: A — Drug-associated acute tubular injury

The best answer is “Drug-associated acute tubular injury”. The piperacillin-tazobactam SmPC reports increased AKI incidence when it is combined with vancomycin. A supratherapeutic vancomycin concentration, rising creatinine and granular casts support acute tubular injury and require prompt dose, indication and alternative-antimicrobial review. “Anti-GBM glomerulonephritis” is less appropriate because the bland granular-cast sediment and drug-level relationship do not support a rapidly progressive nephritic process “Bilateral renal artery thrombosis” is less appropriate because the temporal nephrotoxic exposure and urinary findings provide a more coherent cause “Primary hyperaldosteronism” is less appropriate because this does not cause the described acute creatinine rise and granular casts “Post-renal obstruction despite normal imaging” is less appropriate because there are no obstructive findings and the drug toxicity evidence is strong

Reference: Piperacillin-tazobactam Summary of Product Characteristics: https://www.medicines.org.uk/emc/product/4748/smpc