Antibiotics and Nephrotoxicity


Graded Discussion – Antibiotics and nephrotoxicity
Antibiotics are drugs that are mostly cleared by renal excretion and can be highly nephrotoxic. Explain the mechanisms of nephrotoxic acute renal failure with some antibiotics.
This activity is worth 10%. So we do want you to be relatively detailed on the pathophysiology (i.e. mechanism of disease) aspects. What we want to see is that you understand what are the main mechanisms of drug induced kidney disease. And specifically, which antibiotics and how they cause injury (in terms of kidney). You’ve already highlighted the main two mechanisms (i.e. tubular epithelial cell damage due to acute tubular necrosis and tubulointerstitial disease due to acute allergic interstitial nephritis). So we want to know how do they actually cause the damage. E.g. in the latter for allergic interstitial nephritis – humoral, WCC and which, etc. How do they compare with other mechanisms of drug induced injury (e.g. haemodynamically mediated, obstructive)??? Answering how the drugs cause the damage is the crux of the question.
To add further value, good students in the past applied the mechanism in a clinical context. I.e. they would talk about how each mechanism of injury type might present in a patient (i.e. differences in changes to GFR, urine output, acid base, etc – i.e. how does each mechanism manifest – are they different or not, how might you know if it was one or the other e.g. when do beta lactam type allergic interstitial nephritis present say versus a NSAID induced? this would help you make the appropriate diagnosis and management). What are the ways to prevent or treat?, might an allergic interstitial nephritis present differently when you get a WCC???) So this is NOT the crux of the question, but what it shows it that students were able to critically apply the knowledge on the mechanisms of disease to a clinical context.
Past students have used approx 800-1000 words – quite a factual exercise re: nephrotoxicity mechanism of disease. Good students have shown thoughtful consideration by using examples which are common in day to day practice – e.g. aminoglycosides, vancomycin. They tend to also consider the clinical application (i.e. monitoring, how to minimise)