Learning Objective:
Understand and identify key renal and genitourinary adverse drug reactions, including their causal agents and high-yield clinical pearls, for USMLE Step 1 preparation.
| Drug Reaction | Causal Agents | Notes / High-Yield Tips |
|---|---|---|
| Fanconi syndrome | Cisplatin, Ifosfamide, expired Tetracyclines, Tenofovir | Proximal tubular dysfunction → loss of amino acids, glucose, phosphate, and bicarbonate in urine. Classic Step 1 association: tenofovir toxicity in HIV. |
| Hemorrhagic cystitis | Cyclophosphamide, Ifosfamide | Prevent with Mesna or aggressive hydration. Step 1 pearl: “Cyclophosphamide → Cystitis.” |
| Acute interstitial nephritis (AIN) | Diuretics, NSAIDs, Penicillins, Cephalosporins, PPIs, Rifampin, Sulfa drugs | Immune-mediated; remember the 5 Ps: Pee (diuretics), Pain-free (NSAIDs), Penicillins/cephalosporins, PPIs, rifamPin, sulfa drugs. Classic triad: fever, rash, eosinophilia (but often absent). |
| Nephrotoxicity / Acute tubular necrosis | Cisplatin, Aminoglycosides, Amphotericin B, NSAIDs, Radiocontrast | High-yield: monitor serum creatinine and electrolytes; hydration can reduce risk. |
