19th May 2025

Mr Singh is a 45-year-old man with a background of multiple sclerosis, who has been admitted to the acute medical unit with a catheter-associated urinary tract infection.

Mr Singh is a 45-year-old man with a background of multiple sclerosis, who has been admitted to the acute medical unit with a catheter-associated urinary tract infection. He is prescribed once-daily dosing of gentamicin. Two days into his admission, although his inflammatory markers are trending downward, his glomerular filtration drops to 30% compared with his baseline, with an associated rise in creatinine. What is the MOST likely underlying mechanism of his acute kidney injury? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.