The hallmark clinical feature of drug-induced thrombotic microangiopathy (DITMA) is which of the following?

• A. Chronic liver disease
• B. Electrolyte imbalance
• C. Thrombotic events without kidney injury
• D. Acute kidney injury

Answer: (D)

Drug-induced thrombotic microangiopathy arises from drug-triggered endothelial injury that promotes microvascular thrombi in small vessels. This process commonly injures the kidneys, so acute kidney injury is the most characteristic clinical sign you’ll see. The kidney’s microvasculature is particularly vulnerable to these thrombotic changes, which can lead to a rapid rise in creatinine and other signs of AKI.

Chronic liver disease and electrolyte imbalance aren’t specific hallmarks of DITMA, and many patients do develop AKI due to renal microvascular involvement, not just thrombotic events unrelated to kidney injury. The focus on renal impact helps differentiate DITMA from other conditions that might cause thrombocytopenia or hemolysis but spare the kidneys.