Table 3.

Naranjo nomogram as applied to this patient

1. Are there previous conclusive reports on this reaction? (1/0/0)	1 (Carbimazole has a documented association with nephritis)
2. Did the adverse event occur after the suspected drug was administered? (2/1/0)	2 (Serum creatinine increased 1.75 times above the baseline in the absence of other contributing nephrotoxins)
3. Did the adverse reaction improve when the drug was discontinued or a specific antagonist was administered? (1/0/0)	1 (Serum creatinine returned to baseline within 2 weeks of Carbimazole discontinuation)
4. Did the adverse reaction reappear when the drug was re-administered? (2/1/0)	0 (Carbimazole was not re-administered)
5. Are there alternative causes (other than the drug) that could have caused the reaction? (1/2/0)	2 (The patient’s presentation is not consistent with pre-or postrenal AKI, and no other medication changes were made after Carbimazole initiation)
6. Did the reaction reappear when a placebo was given? (1/1/0)	0 (Placebo was not administered)
7. Was the drug detected in the blood (or other fluids) in concentrations known to be toxic? (1/0/0)	0 (Carbimazole concentrations are not routinely monitored; thyroid function tests did not demonstrate hypothyroidism)
8. Was the reaction more severe when the dose was increased or less severe when the dose was decreased? (1/0/0)	0 (Carbimazole dose was not adjusted; Carbimazole was discontinued)
9. Did the patient have a similar reaction to the same or similar drugs in any previous exposure? (1/0/0)	0 (The patient had not previously taken Carbimazole and had not ever been on propylthiouracil)
10. Was the adverse event confirmed by any objective evidence? (1/0/0)	1 (Laboratory monitoring demonstrated increased serum creatinine, and anti-histone antibodies, which are a feature of drug-induced toxicity, were also positive)
Total points	7 (Probable adverse reaction)