Eosinophiluria AIN Diagnosis — ESENeph MCQ

Correct answer: D — Drug-induced interstitial nephritis with pyuria and systemic hypersensitivity

The best answer is “Drug-induced interstitial nephritis with pyuria and systemic hypersensitivity”. The temporal medicine exposure, rash and sterile inflammatory sediment support acute interstitial nephritis; the suspected medicine should be stopped and biopsy considered if diagnosis or recovery remains uncertain. “Prerenal azotaemia with reduced perfusion and bland urine sediment” is less appropriate because the rash and inflammatory urine sediment point to an interstitial immune process “Post-renal obstruction with hydronephrosis on urinary-tract imaging” is less appropriate because there is no structural evidence and the medicine timing is compelling “Renal-artery stenosis with hypertension and asymmetric kidney size” is less appropriate because this does not cause sterile pyuria and drug-associated rash “Minimal-change disease with nephrotic proteinuria and podocyte injury” is less appropriate because nephrotic proteinuria rather than pyuric AKI would dominate

Reference: KDIGO 2024 CKD guideline: https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf