skip to main content

Acute Interstitial Nephritis — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

EasyAcute Kidney InjuryAcute Interstitial NephritisESENeph

A 52-year-old man presents with AKI (creatinine rise from 95 to 350 umol/L over 5 days). He was started on Amoxicillin 2 weeks ago for a chest infection. He now has a rash, eosinophilia (2.2 x 10^9/L), and fever. Urine shows sterile pyuria and white cell casts. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Acute interstitial nephritis (drug-induced)

The triad of rash, fever, and eosinophilia following antibiotic exposure (Amoxicillin is a common culprit), with sterile pyuria and white cell casts, is classic for drug-induced acute interstitial nephritis (AIN). Management involves stopping the offending drug. Glucocorticoids may be considered if renal function does not recover within 5-7 days of drug cessation, though evidence is limited. Gallium scan or biopsy can confirm the diagnosis.

Reference: KDIGO 2012 – AKI Guideline; Praga and González 2010 – AIN Review