Some medications are known to cause kidney damage because the person is allergic to the medication while others cause direct damage to the kidney because they are toxic at certain concentrations. Risk factors for developing kidney damage have been identified for some medications but not for all. Patients who are exposed to these important medications and develop problems with their kidneys may have some genetic risk. The purpose of this study is to determine the genetic risk factors for drug induced kidney injury. A better understanding of the role of genetics for the development of kidney injury from medications will allow us to better select medications, improve effectiveness of treatment and minimize harm.

Inclusion Criteria:

• Patients age 2 years and older
• Exposure to a candidate drug for at least 24 hours (see above)
• Patients who have developed DIRI as defined by the primary criteria
• Written informed consent or assent and consent obtained
• If patient lacks capacity to consent then surrogate consent will be obtained

Exclusion Criteria:

• Patients with a history of or have a kidney transplant
• Patients with a history of or have a bone marrow transplant
• Patients with Chronic Kidney Disease stage 5 (eGFR < 15 mL/min/1.73m2)
• Patients on 3 or more causal drugs
• Patients with no history or time course on drug exposure
• Patient who, in the opinion of the Investigator, is not suitable to participate in the study.
• Unable to obtain written informed consent or assent
• Unable to obtain surrogate consent for patients who lack capacity

This is a prospective observational cohort study of patients who have developed DIRI. Patients will be identified through two main approaches;

1. Recall and review of medical records of patients who were suspected to have DIRI
2. Concurrent identification of patient under active treatment.

Patients who developed DIRI in their previous care provided will be identified through a review of kidney biopsy logs or nephrology consults previously made.