Which two nephrotoxic agents are most commonly linked to acute kidney injury, with a general preventive strategy of hydration and limiting exposure/monitoring?

• A. Aminoglycosides and Iodinated Contrast Media
• B. NSAIDs and Dehydration
• C. ACE Inhibitors and ARBs
• D. Amphotericin B and Cisplatin

Answer: (A)

Recognizing the two nephrotoxic culprits most often linked to acute kidney injury and the standard preventive approach of hydration and limiting exposure.

Aminoglycosides are classic kidney toxins because they accumulate in proximal tubular cells and trigger acute tubular necrosis. The damage is dose- and duration-dependent and is amplified by dehydration, preexisting kidney disease, advanced age, and concurrent nephrotoxins. Hydration helps maintain renal perfusion and reduces tubular exposure, while careful monitoring of drug levels and limiting duration of therapy lessen the risk.

Iodinated contrast media can cause contrast-induced nephropathy, typically seen as a rise in creatinine within 24–72 hours after exposure. Its mechanism involves renal vasoconstriction and direct tubular toxicity, with higher risk in patients with chronic kidney disease, diabetes, dehydration, large contrast loads, or rapid repeated exposures. Preventive hydration, using the smallest effective dose, opting for low- or iso-osmolar contrast, and minimizing repeated exposures are key strategies.

Other listed options include nephrotoxins as well, but the combination of aminoglycosides and iodinated contrast media is the pair most classically associated with AKI, with hydration and exposure limitation forming the core preventive approach.